Medical Treatment for Respiratory Problems in Neurologically Impaired Children

Doctors at the Pediatric Aerodigestive Center, part of Hassenfeld Children’s Hospital at NYU Langone, may recommend devices that help your child breathe properly. They may also recommend feeding therapy to manage respiratory problems in neurologically impaired children.

Cough Assist Device

If a neurologically impaired child has a cough that is too weak to clear secretions from the lungs, a cough assist device may be recommended. It simulates a natural cough by removing secretions and expanding the lungs, making it easier to breathe.

A cough assist device may be used in children with muscle weakness or partially collapsed lungs, both of which make it difficult to expand the lungs.

It consists of a plastic mask attached to a flexible tube that connects to the device. The mask is placed over the mouth and nose and the device supplies air to expand the lungs, and then reverses airflow to remove secretions. Sometimes, the device is attached to a tracheostomy tube, which is inserted in the windpipe.

The doctor determines how often to use this device each day.

Oscillating Chest Vest

An oscillating chest vest is a lightweight vest connected to an air pulse generator. This generator creates bursts of air that inflate and deflate the vest as the child wears it. This puts pressure on the chest wall, loosening secretions in the lungs and helping a child breathe more easily.

Noninvasive Ventilation

Doctors may recommend noninvasive ventilation to help a child breathe properly and maintain adequate oxygen levels in the body. These devices may be used for children with sleep apnea or other respiratory problems. There are several types of this therapy.

Continuous Positive Airway Pressure

A continuous positive airway pressure, or CPAP, machine creates a continuous flow of air that increases air pressure in the throat. This keeps the airway open.

A small mask, which is connected to the machine by a tube, is placed over the nose or the nose and the mouth. The machine then delivers continuous air pressure to the airway through the tube.

Bilevel Positive Airway Pressure

A bilevel positive airway pressure, or BiPAP, machine can help children with muscle weakness to breathe more easily. This machine delivers two levels of pressurized air through a mask: higher pressure for breathing in, and lower pressure for breathing out.

Gastrostomy Tube

Some neurologically impaired children have difficulty swallowing food or liquids, which can lead to choking or aspiration. In these children, a gastrostomy tube, or G-tube, may be recommended to deliver liquid nutrition made up of carbohydrates, proteins, fats, vitamins, and minerals directly into the stomach.

General anesthesia is used during the procedure to insert the G-tube. An instrument called an endoscope, which is a tube with a camera at the tip, is inserted through the mouth and into the esophagus and stomach. Using the camera to determine the best location for the incision in the abdominal wall, the surgeon makes the incision, inserts the G-tube, and secures it to the abdomen with tape.

This procedure takes 30 to 45 minutes.

Antibacterial Therapy

If a respiratory problem causes lung infections such as aspiration pneumonia, the doctor may prescribe antibacterial therapy—liquid antibiotics that kill bacteria in the lungs.

These medications are given by mouth, through a G-tube, or through a nebulizer, which is a machine that turns liquid medication into a spray the child inhales. Sometimes, antibiotics are provided to prevent infections in children who are prone to aspiration, which is when food, liquid, saliva or other substances are breathed into the lungs.