Many parents have received a prescription for a nebulizer for their child—whether it’s a one-time occurrence for bronchiolitis or reoccurring for a chronic lung disease such as asthma. Nebulizers are used to administer aerosol breathing treatments to help open the airways. Unfortunately, concise usage and care instructions are not always given, so let’s try to clear up some of the typical questions we hear from parents:
What does albuterol do? It is a medication called a bronchodilator that helps open up tightened or constricted airways. It is fast-acting, but doesn’t usually last more than 3-6 hours. While it works to make breathing easier, one of the effects you may notice is your child being “jumpy” following a treatment. Because of this, it’s important to never use it more than every 4 hours unless directed by your physician.
What is the difference between a mask, a mouthpiece and a blowby? If your child is over 4 or 5 years old and is able to follow directions, they should be encouraged to use the mouthpiece while you watch them take every breath. He/she should breathe normally through the mouth and take a deep breath and hold it for 5-10 seconds every 10-15 breaths.An infant or child-sized mask should be used for younger children, but it comes with challenges. If your child is crying they will get little to no benefit from the therapy so it’s best to help them adjust by letting them hold the mask up to their face with no medication being used or show them a sibling or parent that is using the mask. The child also has to be sitting as upright as possible to keep the medication flowing properly in the med cup (Kit/Jet nebulizer).
Although blow-by (putting the mask or flexible tubing close to the child’s nose and mouth) has been used in the past, it is now known to be discouraged.
What is a normal respiratory rate for an infant/child?
Newborn- 6 months 30-60 breaths per minute
6-12 months 24-30 BPM
1-5 years 20-30 BPM
6 years and older 12-20 BPM
How long should a treatment last? A typical unit dose vial of medication should last about 7-10 minutes depending on the machine being used. Tap the sides of the medicine cup when it starts to sputter to bring the droplets back down from the sides. You can do this a few times to get the most medication possible.
How do I know when to give my child a treatment? If your doctor has ordered a specific time frame such as every 4-6 hours, you should follow these instructions. If ordered “as needed,” you’ll want to look for these signs:
- is your child’s breathing becoming faster and more labored?
- is her cough becoming tighter-sounding with wheezing?
- is his respiratory rate becoming faster?
- are symptoms generally increasing?
These are all signs that a treatment is necessary. There are also more severe signs such as lips and nails turning darker/bluish, and much more rapid and labored breathing such as the chest pulling inwards and use of shoulders and neck muscles when breathing. In these cases, give a treatment and call your doctor. One important thing to know is that kids compensate for a long time but then can run out of steam, so it’s important for you to be vigilant at all times. No one knows your child as well as you do.
When should I call my doctor? If symptoms are worsening even after administering breathing treatments every 4 hours, if your child isn’t eating or sleeping for over 24 hours, or if your child has a fever on and off for 2 days along with respiratory symptoms. Trust your judgement.
How do I get new nebulizer kits? The company that supplied your machine will be able to send new kits to you. Their sticker should be on the machine or check for paperwork received. If you don’t know, call your insurance provider and ask them what companies can supply these for you. Check the filter on the machine and replace as necessary. Check an instruction manual if you received one, call your equipment provider or check the manufacturer’s website for more info. Generally, if it looks discolored it will need to be replaced.
Breathe PA has an assistance program that can help you obtain a nebulizer machine if you don’t have insurance coverage.
Please visit our website for more information. In addition, you are always welcome to call us and speak with one of our clinicians.
References: Cleveland Clinic, WebMD, AARC Clinical Practices, Phillips Respironics