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Children’s Chest Physio 101

This winter has brought a stream of babies and children though our doors at Physio Squared with runny noses and nasty coughs. This can be very distressing for parents. We thought it would be a good idea to do a Chest Physio 101, for those interested. We are going to take a look at the detail of how the lungs work and what an infection is but if you want to simply get to the useful tips, scroll to the end of the article.

Our breathing apparatus and how it all works

chest physio respiratory system

If you want to know more about the set-up of the breathing system, we did a blog a few months back titled Breathe your way to your best self.

Any infection affecting the nose, sinuses, pharynx or larynx is collectively called an upper respiratory tract infection.

Any infection affecting the trachea, bronchi, bronchioles, alveoli or pleura (lining of the lung) is collectively called a lower respiratory tract infection. This is used interchangeably with the word chest infection. Pneumonia is a general term that is used, but is actually refers to an infection of the alveoli. These days paediatric doctors will tend to use a specific term to indicate WHERE the infection is based.

An infection always leads to inflammation of the tissue that it is infecting. This is the body’s way of fighting the infection. In medical terms, if something is inflamed, it ends in “itis”. For example, inflammation of the bronchi is called bronchitis. Inflammation of the pleura is called pleuritis. Bronchioles à bronchiolitis. Alveoli à alveolitis.  You get the idea.

The horrible things you cough up are called secretions. You may be more familiar with the words phlegm, snot or catarrh. There are cells lining our bronchi and bronchioles that secrete small amounts of clear, sticky mucous. This mucous traps dirt/germs etc. and filters the air before it reaches the delicate alveoli.

There are tiny hairs called cilia that beat in waves up towards the nose and mouth. These carry the filtered dirt away from the lungs. During an infection, these mucous-secreting cells start over-producing mucous in a desperate attempt to rid the lungs of germs. The cilia become overwhelmed by all the secretions and simply can’t keep up. The body is doing its best to fight the germs. The by-products of this fight are the secretions. The more yellow to green the secretions, the more nasty the infection.

Sometimes the bronchi become so irritated by the infection that they ‘clamp up’. This happens because the smooth muscles encircling the bronchi go into spasm, like a tired or injured muscle. A narrowing of the bronchi occurs and it feels like you are trying to suck the air in through a straw.

chest physio straw

If this happens, the doctor will prescribe a bronchodilator, either via an inhaler or a nebuliser, to relax these muscles and allow the bronchi to dilate back to an acceptable circumference.

chest physio inhaler

Chest Physio

You may be asking yourself, why chest physio? Chest Physio targets clearing up chest infections and is primarily designed to clear the secretions out of the lungs.

When the secretions become copious, they start to ‘clog up’ the lungs, limiting the space available to allow new, fresh, oxygen-rich air into the lungs. The amount of oxygen available to the body starts to drop. This is a big problem, as oxygen is what feeds and nourishes all the cells in our body.

Signs of a decreased oxygen supply to the body include:

  • Increased breathing rate (this is always the first sign)
  • Laboured breathing (usually because of the secretions, bronchospasm or fatigue)
  • Increased heart rate
  • Change in colour – going pale and turning blue around the lips
  • Distress/anxiety
  • Flaring of the nostrils
  • A ‘sucking in’ affect between the ribs

Babies and small children are unable to self-assess and express themselves, so they need to be monitored closely. They are also unable to effectively cough up and clear the secretions. Adults are a lot better at this. Chest physio can be really effective to clear the secretions and ‘open up’ more breathing space.

Knowing the breathing rate

An increased breathing rate is the FIRST cardinal sign of respiratory distress and is the first symptom to manifest when things are going south. You can measure the breathing rate by counting the rise and fall of the chest for 30 seconds, then times this by 2. It can be helpful to gently place your hand on the chest and FEEL the rise and fall. This is a good objective guide to go buy:

Age group                                           Normal breathing rate range (breaths per minute)

Preterm infant                                      40 – 60

Newborn infant                                     30 – 50

Under 2 years                                        20 – 40

2 – 6 years                                              20 – 40

Over years                                               15 – 30

Adult                                                        12-16

What happens at a chest physio session?

  1. We will listen to the chest with a stethoscope – this tells us what is happening inside the chest and where the secretions are hiding.

chest physio stethoscope

  1. If the secretions sound thick and slow to move, we will administer a saline nebuliser to loosen up the secretions. Sometimes the doctor will prescribe a nebuliser with a bronchodilator or an anti-inflammatory to settle the bronchi.

chest physio neb

  1. Based on our assessment, we will position the baby/child in a way that facilitates drainage of the affected area.
  2. We will use a range of manual techniques to assist the secretions to ‘shake loose’ and move out of the lungs. This may include clapping the chest wall (called percussion) or placing a vibrating pad over the chest wall.
  3. If the child is old enough to follow, we will use a number or breathing techniques to help the secretions to clear. Sometimes, if a sample of the secretions are required, we will use a special suction machine to suck the secretions up into a bottle to be taken to the lab for testing.
  4. We will advise the parent/family around management of the chest at home.

At times the doctor will prescribe an antibiotic to help fight the infection or they will first ask for a sample of the secretions to be tested. This means they can find the exact bug causing the infection and treat it specifically. It is often the physio’s job to get that secretion sample to send for testing.

Handy chest tips:

Both upper and lower respiratory tract infections can cause sleepless nights. When your little one lies down, secretions from the lower airways move upwards causing coughing. In addition, most children breathe through their nose (especially those who need a dummy to sleep). So a really blocked nose can cause very tired parents and children. Thankfully there are things you can do.

Making the mucous thinner

This is so that it is easier to expel it from the body. The following ways work well:

  • Nebulising with saline will thin the mucus in your child’s lower and upper respiratory tract.
  • A humidifier in their room is often helpful.
  • Saline nasal sprays are great at thinning and loosening mucus in the nasal passages. The aerosol type (such as Sterimar) forms a very fine mist and works particularly well.
  • If you don’t have any of the above, even running a hot shower and putting your child in the steamy bathroom for a short while will help.

chest physio stethoscope

Helping your child to expel the mucous once it is thinner

For a lower respiratory infection your physio can teach you how to percuss (cup) your child’s chest in order to aid removal of secretions. It is wise to do this at least an hour or two before they go to bed as the mucus you have loosened continues to come up for a while and you don’t want your little one awake coughing.

In the case of an upper respiratory infection or nasal congestion a nasal aspirator (AKA snot sucker) is helpful. Sometimes a post nasal drip can cause a lower respiratory infection as the mucus drips into the child’s chest, so it is a great idea to clear their nose.

There are different options:

  1. Bulb aspirator
  2. Nasal vacuum
  3. Nose Frieda

In my opinion, the bulb aspirator is not hugely helpful (I have tried 4 different brands).

The nasal vacuum works very well, but needs to be connected to a vacuum cleaner – which is not ideal in the middle of the night or if you are looking for something portable.

The nose Frieda seems a bit disgusting, but works very well. There is a pencil shaped tube that you put against the babies nostril. You suck on the other end of the tube to draw the mucus out. Luckily there is a sponge that stops it going all the way through into Mom (or Dad’s) mouth!

chest physio suction

Sleeping position

Once you have cleared as much mucus as possible, it may be helpful to elevate the head and chest with a foam wedge (available in all baby shops). This aids breathing and reduces night time coughing.


A post nasal drip may make your little one a bit nauseous, it is also hard to feed with a blocked nose. Many children therefore don’t have a great appetite. It is very important to make sure that they stay hydrated by offering liquid regularly.

Disclaimer: Although this advice is tried and tested and follows research protocols, Physio Squared cannot take any responsibility for injuries or health conditions that may arise as a result of following the advice. If you have any concerns about injuries or conditions you currently have, please seek a medical assessment by your local health professional or physiotherapist.


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