Postural drainage for children under one year old, 3-4-6-8 years old. Algorithm

Postural drainage is an effective method for evacuating mucous membranes. contents from the bronchial cavityaffected by an infectious and inflammatory process. The procedure is indicated for children of all age groups. The therapeutic properties of postural massage are enhanced in the case of prior administration of mucolytic drugs.

The advantage of using this method for evacuating mucus from the bronchi is that it can be used not only in hospitals, but also at home. In order to independently perform postural massage for a child with bronchitis or pneumonia, it is enough to follow the generally accepted algorithm of actions.

The essence of postural drainage

Postural drainage is a therapeutic procedure, the essence of which is to ensure the gentle removal of phlegm from the lumen of the bronchi. By its nature, the origin of mucus that accumulates in the organs of the respiratory system is the result of the pathogenic activity of pathogenic microorganisms.

The causative agents of viral and bacterial infections that provoke the inflammatory process, irritate the bronchial mucosa, and cause the release of a specific effusion. For children under 12 months. coughing up accumulated phlegm is a very difficult task, since they do not have a well-developed cough reflex. In this case, the use of postural massage can speed up the process of cleansing the lungs from mucous contents.

A child aged 3 to 8 years is able to independently cough up phlegm that has accumulated in the bronchi. This type of mucus evacuation is possible only if the contents of the lumen of the bronchial tree are sufficiently liquid. In clinical cases, when the inflammatory process in the bronchi becomes chronic, the sputum acquires a viscous and too thick consistency.

In this situation, complete evacuation of mucus from the respiratory system is impossible without the use of mucolytic drugs and the correct implementation of postural drainage techniques. Under the influence of massage movements, the effect of mucus flowing from the smaller ones to the large and main bronchi is achieved with its further flow into the trachea.

Indications for postural drainage for children

Postural drainage is considered completely safe and approved for use in infants.

This therapeutic procedure is included in the course of complex therapy for patients with the following types of diseases:

• bronchitis;
• pneumonia;
• ARVI with the spread of infectious pathogens into the lumen of the bronchial tree;
• bronchopneumonia;
• stagnation of pathogenic exudate in the bronchi (for example, if the child has had bronchitis, pneumonia, and a complication of these diseases is the preservation of the residual amount too thick and viscous sputum).

Postural drainage for children is prescribed by a pediatrician or pulmonologist after a comprehensive examination of the child's respiratory system. The causal factors that provoked the accumulation of mucus in the bronchi, and also prevent its natural evacuation with the help of coughing, are mandatory established.

Contraindications

Postural massage is contraindicated for use in children who have been diagnosed with the following diseases and pathological conditions of the body:

• acute form of pneumonia;
• severe diseases of the cardiovascular system, which cause impaired general circulation;
• respiratory failure;
• all types of seizures;
• a feverish condition, accompanied by an increased body temperature;
• exacerbation of chronic bronchitis;
• ascites;
• the presence of a reasonable suspicion of intracranial bleeding;
• chest and spine injuries;
• aortic aneurysm;
• heart rhythm disturbances;
• malignant neoplasm in the tissues of the lungs;
• tuberculosis.

In the presence of the above pathologies, the use of postural drainage techniques can exacerbate the disease state of the body, provoke a deterioration in general well-being.

Types of postural drainage

Postural drainage for children is classified into several main types. These are static and dynamic procedures and are detailed in the table below.

Types of postural drainage	Description of the therapeutic procedure
Static postural drainage	Static postural drainage provides a minimum of patient interventions. The child takes the starting position in a supine, stomach or side position. Throughout the entire therapeutic process to stimulate a more active outflow of sputum, the patient does not move. This type of postural massage is used to treat children with residual signs of bronchitis, local accumulation of a small amount of mucus inside the lumen of the bronchi.
Dynamic postural drainage	Postural drainage of a dynamic type is carried out with a rhythmic change in the position of the patient's body. At the command of the doctor, the child sits down on a chair, takes a lying position on its side, then turns over on its stomach. The nature of the therapeutic actions associated with a constant change in the patient's position depends on the complexity of the bronchial disease and the prevalence of sputum within the respiratory system. Postural drainage of a dynamic type involves the use of auxiliary techniques aimed at a more active outflow of exudative mucus. For example, taking mucolytic drugs, using steam inhalation with the addition of medicinal solutions.

The attending pediatrician or pulmonologist independently determines the type of postural drainage that should be used in the process of complex treatment of a child with signs of chronic bronchitis, complications of pneumonia or stagnant processes in the bronchi.

Purpose and results of the procedure

Postural drainage for children is a therapeutic chest massage that should only be performed after a preliminary examination of the child. The purpose of this procedure is to accelerate the physiological process to remove foreign sputum from the lumen of the bronchi.

The result of a successfully performed postural massage is the cleansing of the bronchial tree not only from mucous contents, but and from pathogens that provoke tissue inflammation, as well as toxins released during their life activity.

Preparation for treatment sessions

Before starting the postural drainage procedure, you must do the following:

• Place a container near the child's bed, which will act as a spittoon.
• Make sure that the surface on which the patient will lie is firm and level.
• Bring a hypoallergenic baby cream to be used during the chest drainage massage.
• Prepare a clean, dry towel or diaper.

The container, which will act as a spittoon, must undergo antiseptic treatment with a 5% Chloramine B solution. After performing the disinfecting manipulations, the spittoon is located in the immediate vicinity of the bed so that the child can spit out the exudate during coughing.

Positional drainage in small patients under one year old

Postural drainage for infants younger than 12 months is performed with extreme care to minimize the risk of injury to the bones of the chest, ribs, and spine. For a child under 1 year old, this procedure is performed on an empty stomach. Otherwise, the likelihood of vomiting increases. The optimal time for postural drainage for an infant is the first 20 minutes. after completing daytime or nighttime sleep.

At this time, there is an improvement in local blood circulation in the lungs and bronchial tree, which increases the therapeutic effectiveness of postural massage. Before starting the treatment, the child is given a children's syrup with mucolytic properties, which is prescribed by a pediatrician, taking into account the individual characteristics of the patient's general health.

The infant is placed in a prone position on the knees so that the lower body remains slightly elevated in relation to the torso and head. This will provide a natural slope for the drainage of sputum from the bronchi in the direction of the trachea.

Then the masseur does the following:

1. Treats hands with pre-prepared baby cream.
2. Applies part of the cream to the surface of the baby's skin to be massaged.
3. The specialist strokes the back of the newborn with slow movements, which can be linear or have a spiral direction.
4. Immediately after light stroking, drainage massage techniques are performed to create a vibration effect. To do this, light tapping is carried out on the chest using the edge of the palm.

During postural drainage of the respiratory system, the healthcare professional does not work on the areas of the chest where the spine and heart muscle are located. In the process of performing light tapping, it is necessary to ensure that the massage vibrations do not affect the kidneys.

The duration of postural drainage, including therapeutic massage, is at least 20 minutes. At the end of the therapeutic procedure, the child should be in a horizontal position. To achieve a positive therapeutic effect, postural massage should be performed 2 to 3 times a day with the duration of the total course of therapy for 7 days.

Algorithm for postural drainage for children from one year and older

For children aged 3 to 8 years, who can follow all the doctor's commands, several postural drainage techniques are used, depending on the severity of the clinical case.

Option number 1

One of the most effective postural drainage techniques is a combination of therapeutic massage while changing the position of a sick child.

The algorithm for carrying out the procedure provides for the following actions:

1. Lay the child on his back.
2. Perform massage of the anterior chest wall, accompanied by light tapping with your fingers.
3. After 5 minutes. therapy ask the child to slowly roll over on its side.
4. Then the patient should take 2-3 deep breaths and exhale the air.
5. When a wet cough appears, the child must be given the opportunity to cough up well, and the secreted sputum spits into a previously prepared container.
6. After that, the patient turns over from the side to the stomach.
7. During the first 3 min. a leisurely stroke of the back surface is performed to improve local blood circulation, and then massage is performed with light tapping of the chest.
8. After 5 minutes. the child takes deep breaths again, and after exhaling air, a cough should occur with the evacuation of sputum.

This postural drainage technique can be used 3 to 6 times a day, depending on the general condition of the child and the dynamics of the outflow of mucous exudate.

Option number 2

This method of removing sputum using postural drainage is used if the mucous contents of the bronchi are too thick, and also does not evacuate from the supine position.

In this case, you will need to follow the algorithm of actions:

1. The child should take a knee-elbow position, leaning slightly forward.
2. The patient is in this position for at least 1 minute.
3. Then the child lies on his stomach.
4. A massage of the patient's back is performed, vibrational tapping is performed along the entire plane of the chest.
5. After that, at the command of the doctor, the child again takes the knee-elbow position, tilting the body forward.
6. The patient is in this position for at least 1 minute.
7. Then the child again lies on his back and receives a vibration massage of the chest.

This therapeutic procedure is performed 4 to 6 times a day. During a postural drainage session using this technique, the child should perform at least 6-8 bends. After the completion of the procedure, the patient begins to cough, along with which accumulated sputum comes out.

Option number 3

This method of performing postural drainage is used for sick children, in whose bronchi a large accumulation of thick sputum is found.

The technique of the therapeutic procedure is as follows:

1. The specialist performing the drainage massage explains to the child that after receiving the command, he needs roll over from side to side, and then hang his head and arms out of bed as if he were looking for slippers or socks.
2. Then the child takes a position lying on the left side.
3. The patient receives a massage of the thoracic back with vibratory tapping.
4. After 5 minutes. the child turns over on its right side.
5. The specialist continues to massage the patient's chest.
6. After 5 minutes. the child should hang his head and arms off the bed, ensuring the maximum tilt of the chest for a quick outflow of mucus.
7. The patient is in this position for 2-3 minutes, and then takes several deep breaths.

After performing the above manipulations, the child should begin a wet cough with sputum waste. This postural drainage procedure is carried out 5 to 6 times a day, depending on the general dynamics of the patient's recovery.

Option number 4

This postural drainage technique is also known as the Quincke Technique.

To apply this method of forced evacuation of sputum from the bronchi, the following sequence of actions must be followed:

1. The child lies on the bed, lying on his stomach.
2. The hospital staff raise the foot edge of the bed to a height of 20-30 cm.
3. The bed is in this position for 20 minutes.
4. After the specified period of time, the bed returns to a strictly horizontal position.
5. For 10-15 minutes. the specialist performs a massage of the thoracic spine of the child, conducts vibration tapping with his fingers.
6. Then the foot edge of the bed rises again to a height of 20-30 cm, and after 20 minutes. returns to its original position.

Upon completion of the therapeutic procedure, it is necessary to help the child to take a comfortable position. The first 3-5 minutes. after postural drainage, a severe cough may occur with the release of a large amount of mucous exudate. This is a normal reaction of the respiratory system to measures taken to force sputum outflow. The cuspidor should be placed closer to the head end of the bed so that it is easier for the child to get rid of the mucus that is secreted.

Precautions and possible consequences

During postural drainage of bronchial contents, the following precautions must be observed:

• do not make sudden movements;
• vibrational tapping should be rhythmic, but not strong;
• do not hit the spine;
• monitor the general condition of the child;
• do not apply compression pressure on the central part of the anterior chest wall.

Violation of the above recommendations can lead to injuries of the thoracic spine, damage to the ribs and bone tissue of the sternum.

Postural drainage is a therapeutic procedure that is indicated for use in chronic bronchitis, the presence of complications associated with pneumonia. This method of treatment involves performing vibration massage of the chest for a faster outflow of too thick and viscous sputum from the bronchial cavity.

Postural drainage is allowed for children under 12 months of age. Babies in need of forced removal of sputum from the bronchi undergo a therapeutic procedure while in the prone position without changing this position. Older children receive a dynamic type of postural drainage with inversion on the left and right sides, the surface of the abdomen and back.

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