Paediatric chest physiotherapy for mucus clearance

Chest physiotherapy for mucus clearance may be seen as a therapeutic application of respiratory physiology; the basic mechanical principles do not differ between the treatment of paediatric and adult patients. However, children present with a developmentally defined, age-specific situation regarding respiratory structure and function that calls for a specialised therapeutic approach. Inspiration dilates bronchi and thus brings air behind obstructing mucus plugs. Newborns and infants have the special problem of an overly compliant, instable thorax and an easily obstructed upper airway; hence they require special help with lung volume management. Forced expirations mobilise and transport secretions by expiratory airflow in combination with a wave of moving choke points. Early in life, low stability of airways threatens to hamper this mechanism by complete closure; this calls for special therapeutic assistance. Positioning regionally modifies ventilatory excursions and is thus used to target gas-liquid pumping. However, lateral decubitus position does not affect ventilation in children in the same way as in adults. Disease-inflicted changes of structure and function call for further modification of the therapeutic approach. Finally, the psychology of therapist-patient interaction differs substantially between different age groups.