How to Provide Postural Drainage Chest Percussion and Chest Vibration in Children

Postural drainage, chest percussion, and chest vibration are methods of clearing mucus out of your child’s lungs. Thick or sticky mucus in the lungs can block the airway and cause serious problems. Regularly doing postural drainage, percussion, and vibration as part of your child’s normal medical care can help prevent mucus buildup. These methods can be combined or done separately, depending on what your child’s health care provider recommends.

Postural drainage involves having your child sit or lie in certain positions so that mucus can drain by gravity. The positions that your child uses are important because they put your child’s lungs in the best position for drainage. Chest percussion involves tapping your child’s chest or back with your hand. For chest vibration, you use your hand or special equipment to vibrate your child’s chest and back.

For postural drainage, percussion, and vibration, follow instructions from your child’s health care provider about:

• Which positions your child should use.
• When and how often to perform each method.
• How long each drainage session should last.

What are the risks?

If postural drainage, chest percussion, or chest vibration are done within 1 hour after your child eats, your child’s risk for vomiting or acid reflux may increase. Acid reflux is when stomach acid flows up into the tube that connects the mouth and the stomach (esophagus). Percussion and vibration can also cause skin irritation or bruising if done too forcefully.

To reduce these risks:

• Have your child wear light, soft clothing during percussion or vibration. Do not perform percussion or vibration on your child’s bare skin.
• Remove any jewelry from your hand and wrist before doing percussion or vibration.
• Avoid doing postural drainage, percussion, or vibration during the hour that follows a meal or snack.

How to perform postural drainage

Have your child get into his or her recommended positions for as long as told by his or her health care provider. After each position, have your child breathe in (inhale) deeply and then breathe out (exhale) forcefully. When exhaling, have your child say “huff.” Have your child do this several times, and then cough.

Follow instructions from your child’s health care provider about what time is best for doing postural drainage. Performing it in the morning can clear mucus that has built up at night. Postural drainage near bedtime may decrease nighttime coughing.

How to perform chest percussion

1. Have your child get into the recommended position.
2. Shape one of your hands as if you are cupping water in your palm. Tap your child’s back or chest with the palm of your cupped hand. This should not cause your child discomfort.
   1. Tap quickly, at regular intervals. The tapping should make a hollow sound.
   1. Do not tap over the kidneys, which are in the middle-to-lower back on each side of the spine.
   1. Do not tap over the spine.
   1. Do not tap over girls’ breasts.
   1. Follow advice from your child’s health care provider about how much force to use and how long to tap. In most cases, you should tap for about 3–5 minutes per position.
3. Repeat for each position.
4. Have your child inhale deeply and then exhale forcefully. When exhaling, have your child say “huff.” Have your child do this several times, and then cough.

How to perform chest vibration

Vibration shakes mucus out of airways in the lungs. This can be done with your hand (manually), an inflatable vest (high frequency vest), or a vibrating mouthpiece (flutter).

Manually

1. Have your child get into the recommended position.
2. Flatten your hand and place your hand palm-down on your child’s chest or back. Tense your arm and shoulder, press lightly, and make a rapid shaking motion. It may help to place one hand on top of the other.
3. Vibrate for about 15 seconds at a time, or for as long as told by your child’s health care provider.
4. Repeat this as many times as your health care provider recommends for each position.
5. Have your child inhale deeply and then exhale forcefully. When exhaling, have your child say “huff.” Have your child do this several times, and then cough.

With a High Frequency Vest

To use this method, your child wears an inflatable vest that is connected to an air generator. The generator delivers air into the vest, which vibrates your child’s lungs.

1. Place the vest on your child.
2. Have your child get into the recommended position.
3. Turn on the vest for as long as told by your child’s health care provider.
4. Stop the vest every 5 minutes to have your child inhale deeply and then exhale forcefully. When exhaling, have your child say “huff.” Have your child do this several times, and then cough.
5. Repeat this as many times as your health care provider recommends for each position.

With a Flutter

A flutter is a tube-shaped device. Your child puts his or her lips around one end of the flutter, then exhales into it. This makes a ball move inside the flutter, causing vibrations in your child’s lungs. Your child’s health care provider will show you and your child how to use the flutter.

1. Have your child get into the recommended position and hold the flutter in his or her mouth.
2. Have your child inhale deeply and exhale forcefully into the flutter as many times as told by your child’s health care provider.
3. Have your child inhale deeply and then exhale forcefully. When exhaling, have your child say “huff.” Have your child do this several times, and then cough.

Contact a health care provider if:

• Your child has a fever.
• Your child begins to cough up more mucus.
• Your child has a cough that does not go away.

Get help right away if:

• Your child has difficulty breathing.
• Your child coughs up blood.
• Your child has pain that gets worse or does not improve with medicine.