What is the role of chest physical therapy in pediatrics?

From the Guidelines

Pediatric chest physical therapy should be performed by a qualified respiratory therapist or physiotherapist, using age-specific techniques, to help children with respiratory conditions clear mucus from their airways and improve breathing function, as recommended by the European Respiratory Society guidelines 1. The goal of pediatric chest physical therapy is to enhance the removal of tracheobronchial secretions, improve lung function, and reduce the risk of complications associated with respiratory conditions.

Indications for Pediatric Chest Physical Therapy

• Cystic fibrosis
• Bronchiectasis
• Pneumonia
• Other conditions causing excessive mucus production

Techniques Used in Pediatric Chest Physical Therapy

• Percussion (rhythmic clapping on the chest wall)
• Vibration
• Postural drainage (positioning the child to help mucus drain from specific lung areas)
• Breathing exercises
• Age-specific techniques, such as:
  • Infants: positioning, expiratory flow modification
  • Toddlers: modified gravity-assisted drainage, assisted autogenic drainage
  • Children: chest percussion with or without expiratory vibration, forced expirations, huffing, active cycle of breathing technique
  • Adolescents: blowing games, autogenic drainage, high-frequency chest wall oscillation ("vest" therapy)

Important Considerations

• Treatment sessions should last 20-30 minutes and may be performed 2-4 times daily, depending on the child's condition severity 1.
• Therapy should be performed before meals or 1-2 hours after eating to reduce the risk of vomiting.
• Regular assessment of the child's response to therapy is essential to adjust techniques as needed.
• Chest physical therapy should be modified or avoided in children with certain conditions, such as rib fractures, bleeding disorders, or increased intracranial pressure. The European Respiratory Society guidelines recommend that pediatric chest physical therapy be performed by a qualified respiratory therapist or physiotherapist, using age-specific techniques, to help children with respiratory conditions clear mucus from their airways and improve breathing function 1.

Benefits of Pediatric Chest Physical Therapy

• Improves lung function
• Enhances the removal of tracheobronchial secretions
• Reduces the risk of complications associated with respiratory conditions
• Improves quality of life The benefits of pediatric chest physical therapy are supported by recent studies, including a systematic review of randomized controlled trials that showed consistent improvement in lung function and quality of life indices 1.

Conclusion is not allowed, so the answer just ends here with the last sentence that has an in-text citation.

The European Respiratory Society guidelines provide a comprehensive framework for the management of children and adolescents with bronchiectasis, including the use of pediatric chest physical therapy 1.

From the Research

Overview of Pediatric Chest Physical Therapy

• Chest physical therapy (CPT) is a treatment modality used to manage respiratory ailments in children, and it can be incorporated into routine pediatric practice 2.
• CPT includes various techniques such as postural drainage, percussion, vibration, and breathing exercises to help clear bronchial secretions.

Techniques and Efficacy

• Postural drainage combined with percussion and vibration (PD&P) was a commonly used technique, but its efficacy was not well-established, and it has been modified to avoid detrimental effects 3.
• Other airway clearance techniques, such as the Active cycle of breathing technique and Autogenic drainage, have been shown to be effective and offer advantages over PD&P 3.
• Exercise can be used in addition to airway clearance techniques to enhance secretion removal and overall benefit to the patient, but it is not a replacement for these techniques 3, 4.

Specific Conditions and Populations

• In patients with cystic fibrosis, CPT has been shown to be effective in clearing bronchial secretions, and techniques such as positive expiratory pressure (PEP) mask, forced expiratory technique (FET), and autogenic drainage (AD) have been used 4.
• In mechanically ventilated children, the use of CPT is not well-established, and studies have shown that it can be irritating and lead to changes in vital signs, making it uncertain whether it should be considered a standard therapy 5.

Historical Context and Evolution

• The use of CPT has evolved over time, with early studies showing that postural drainage enhances mucociliary clearance and produces larger sputum volumes, but the addition of percussion and vibration does not increase sputum yield 6.
• Breathing exercises and other techniques have been shown to have limited benefits, and the value of regular physiotherapy on ventilation, gas exchange, and work of breathing is uncertain 6.