Incentive spirometry in pediatrics is a therapeutic technique that encourages children to take deep breaths using a handheld device, helping to prevent or reverse atelectasis, improve lung expansion, and promote airway clearance—especially after surgery or during prolonged bed rest.
Purposes
- To increase transpulmonary pressure and inspiratory volume
- To improve inspiratory muscle performance
- Improves oxygenation and ventilation
- To re-establish or stimulate the normal pattern of pulmonary hyperinflation
- To prevent or reverse lung atelectasis
Indications for Incentive spirometry
- Children who undergone any surgery that might jeopardize respiratory function, for example, thoracic surgery or upper abdominal surgery.
- Children recovering from anesthetic effect
- Pulmonary atelectasis
- Presence of a restrictive lung defect associated with quadriplegia and/or dysfunctional diaphragm.
Preparation
- Explain the procedure to the child and demonstrate it if necessary.
- Take return demonstration during preoperative period. So that he can follow the technique during the postoperative period.
Procedure
- With the unit in an upright position, have the child blow the air out of his lungs (exhale). Have him place his lips tightly around the mouthpiece.
- Have the child take a deep breath (inhale) enough air to raise the flow rate guide between the arrows.
- Have the child to hold the deep breath, continue to inhale, and keep the guide as high as he can for as long as he can.
- Have the child exhale and relax. After each deep breath, take a moment to rest, relax, and breathe as normal. Then repeat the steps as directed.
- Cough after 10 deep breaths.
Nurse’s Responsibility
- Assess the child’s condition and ability to follow instructions.
- Instruct the child and parents about proper technique and an understanding of the importance of preoperative instructions.
- Constantly monitor the child during therapy.
- Encourage the child to perform independently.
- Maintain universal precautions to prevent transmission of infection between children.
Contraindications & Precautions
- Uncooperative or cognitively impaired children
- Severe respiratory distress or fatigue
- Facial trauma or recent oral surgery
- Monitor for dizziness, fatigue, or desaturation
Cultural Considerations
- Use lingual instructions and culturally familiar analogies
- Respect modesty and privacy during positioning
- Involve family members in home-based spirometry routines when prescribed
- Emphasize preventive value in terms of family health and recovery
Special Considerations
- Use age-appropriate language and visuals to teach the technique.
- Turn it into a game (e.g., “make the ball dance” or “reach the star”).
- For younger children, practice preoperatively to build familiarity.
- Monitor for fatigue, dizziness, or poor technique.
- Replace the device as per manufacturer guidelines or if visibly damaged.
- Avoid sharing devices between children to prevent cross-contamination
- For children under 4–5 years, consider bubble blowing or pinwheel games as alternatives.
- Children with asthma or wheezing may need a respiratory therapist’s input before use.
REFERENCES
- 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
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- 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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