Nebulization in Pediatrics

Nebulization in pediatrics is a cornerstone therapy for delivering aerosolized medications directly into the lungs—especially useful for children who are too young or uncoordinated to use inhalers effectively. It’s commonly used in conditions like asthma, bronchiolitis, pneumonia, and cystic fibrosis

A nebulizer is an electrically powered machine that turns a liquid medication into a mist so that it can be breathed directly into the lungs through a face mask or mouthpiece.

Drugs Used for Nebulization Therapy

• Bronchodilators
• Mucolytic drugs
• Decongestant drugs
• Anti-inflammatory drugs (e.g., salbutamol, terbutaline, salmeterol, beclomethasone, budesonide, and ipratropium)

Dosage and Frequency

Usually depends on doctor’s prescription. For the salbutamol the dosage is:

• Up to 3 years: 0.1 mL Asthalin + normal saline 2 mL
• 3-12 years: 0.5 + 2 mL

Equipment Needed

     A clean tray containing:

• Nebulizer machine with accessories
• Sputum cup with disinfectant solution to collect if coughed out
• Kidney tray to collect the waste
• Stethoscope to auscultate the breath sounds
• Face towel for wiping the face
• Hand towel to dry the hands
• Medicine as prescribed
• Bowl with sterile swabs to clean the accessories before and after the procedure
• Spirit for disinfection of accessories
• Dropper or disposable syringe to measure and to pour the medicine
• Additional set of face mask, tube, and accessories to meet the emergency
• Watch to note the timing

Instructions

• Always keep an extra nebulizer or its accessories in hand. Prior to using the machine, check for its working condition.
• If the treatment is longer than 10-15 minutes, check if the mist output nebulization may be clogged or dirt can obstruct the airflow from the compressor.
• If the treatment is shorter than the normal, check to see if the medicine is leaking out of the nebulizer.
• The nebulizer must not be touched with wet or soaked hands.
• No smoking, no fire around the equipment when in use.
• Do not pour medication solution >10 mL
• into the medication cup.
• Filter should be changed when it turns completely gray in color.

Nebulization Therapy

Methods

• Mouthpiece treatments for children ages 8 years and older. The child places the mouthpiece between the teeth, using the lips to form a tight seal.
  Disadvantages:
• May not be effective when the child is sleeping.
• Mask treatment (children <8 years): An aerosol mask is placed on the nebulizer and then secured over the nose and mouth of the child. The mist breathed in through the child’s mouth and nose. Placing the mask on a young child can be scary.
• Blow by treatment (very small infants or children who cannot tolerate mask treatment).

This method directs the mists at the patient’s nose or mouth through a flex tube. It sends very little medication to the infant’s lungs.

Preparation

• Explain the procedure to the parents and child.
• Select the quite area for the treatment to avoid disturbance and enhance comfort.
• Clean the nebulizer and its accessories with a spirit swab.
• Prior to using, check the nebulizer parts for cracks or damage of material inside.

Procedure

• Assemble the articles near to the procedure area.
• Pour prescribed medicine in correct dilution in nebulizer and cover it with dome tightly.
• Wash hands.
• Place the child in an upright position and auscultate for breath sounds.
• Place the face mask/mouthpiece correctly in place and instruct the child to take a deep breath through the mouth.
• Switch on the nebulizer and keep it upright.
• Depending on the amount of medication to be used, the treatment will usually last 10-15 minutes.
• When the nebulizer splutters, shake or tap it once or twice. If it continues to splutter, the treatment is done.

Post procedure Care

• Provide the child a comfortable position and encourage the child to effectively cough.
• Check the breath sounds and corelate with the preprocedural auscultation for changes.
• Check vital signs.
• If perspiration is present wipe the child’s face with the face towel.
• Wash hands and replace the articles.
• Record the procedure and the vital signs in nurse’s record.

Care of Nebulizer

• After each use the nebulizer must be cleaned.
• Dismantle the mouthpiece, nose piece, or face mask from cap, open nebulizer cup and remove baffle.
• Wash it with soap and rinse under hot tap water.
• Allow to air-dry.
• Keep the outer surface of the tubing dust free by wiping regularly with the clean and dry cotton swab daily.
• Use dry clean cloth to clean the outer part of the nebulizer.

REFERENCES

1. Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
3. Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
4. Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840.
5. Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/

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