Paediatric Physiotherapy Notes

Physiological Differences Between Paediatric and Adult Lung

• Trachea diameter: $5mm$ (adult $14mm$).
• Lung surface area: $2.8m^2$ (birth), $32m^2$ (8 years), $75m^2$ (adult).
• Upper airway: Nasal breathing (adults: nasal/mouth).
• Collateral ventilation: Not developed until 4-8 years.
• Bronchial walls: Less cartilage, less muscle, more glands.
• Tidal Volumes: $16ml$ (adult $500ml$).
• Ribs: Horizontal (adults: bucket handle).
• Thoracic Cage: Softer (more compliant).
• Respiratory Muscles: Fewer slow twitch fibres, leading to fatigue.
• Lung Compliance: High chest wall compliance (adults stiffer).
• Alveoli: Fewer (20 million vs. 300 million until 8 years).

Normal Values for Infants and Children

• HR, RR, BP vary with age.
• Infant HR: ~$120$ bpm (Tachycardia >$180$ bpm, Bradycardia <$100$ bpm).
• Infant RR: $30-40$ bpm (Tachypnoea >$60$ bpm with distress signs).

Recognizing Respiratory Deterioration

• Signs of respiratory distress: tachypnoea, recession, nasal flaring, expiratory grunting, cyanosis, altered breath sounds.
• Other signs: tachycardia, bradycardia, neck extension, head bobbing, pallor/blotching, altered consciousness.
• Recession: Indrawing of chest wall (intercostal, subcostal, supraclavicular, suprasternal/xiphoid).
• Nasal flaring: Dilatation of nostrils.
• Expiratory grunt: Expiration against partially closed glottis to maintain positive pressure.

Principles of Airway Clearance

• Caution with techniques generating negative intrathoracic pressure (e.g., suction, vibrations, cough).
• Use techniques with positive pressure (e.g., CPAP, manual hyperinflation).
• High prevalence of airway closure/atelectasis in infants.
• Positioning: Greater airflow into non-dependent side.
• Manual treatments: Percussions, vibrations (use cautiously), clearance of secretions.

Common Chronic Respiratory Diseases

• Asthma: Breathlessness and wheezing due to airway narrowing; physiotherapy rarely needed unless mucus is a factor; acute management can be potentially fatal.
• Bronchiolitis: Bronchiolar inflammation (usually viral); physiotherapy has no benefit unless ventilated with collapse/mucus plugging.

Acute Respiratory Illnesses

• Pneumonia: Lung infection (bacterial or viral); features include fever, cough, tachypnoea; managed with antibiotics.

Prone Lying as a Respiratory Treatment

• Limited evidence in paediatric patients.
• Improves aeration and V/Q matching.
• Minimal adverse events if monitored.

Cough

• Single most common presenting symptom.
• Chronic wet cough: Daily wet cough >4 weeks.
• Protracted Bacterial Bronchitis (PBB): Daily wet cough >4 weeks without specific cause, responds to antibiotics. Most common cause of chronic wet cough.

Bronchiectasis

• Progressive disease with dilated, thick-walled bronchi associated with infection and inflammation, diagnosis on HRCT.
• Often preceded by PBB.
• Excessive lung insults contribute (e.g., chronic aspiration, smoke exposure).

Culturally Secure Care for Aboriginal Children

• Clinicians must ensure cultural competency.
• Build trust through kindness, understanding context, and informal conversation (“yarn”).
• Engage family in conversation and allow time for response.

ACT (Airway Clearance Techniques)

• Should reduce infection episodes and further lung damage.
• Includes devices like PEP mask, Bubble PEP.
• Huffing technique and cough stimulation to clear secretions.

Bronchomalacia (BM)

• Lack of bronchial rigidity leading to collapse and atelectasis.
• FET should consist mostly of LV ‘slow’ huffs. Attempt to support or assist cough.