16 answers

16 Month Old Refusing Necessary Nebulizer Treatments

My 16 month old daughter needs 4x daily nebulizer treatments. The doctor says the mask will not do, she must put the nozzle in her mouth and inhale or breathe in the medicine. My daughter clamps her jaw shut, turns her head side to side and grabs at the nozzle. If I manage to get it in her mouth - she sticks her tongue in it and essentially stops it up. As I type this I see the humorous picture - but starting each morning and ending each day this way is a nightmare. We have tried putting it in our mouths, showing her how, letting her hold it and put in, turning on a video, etc - nothing works She must have the treatment, (the liquid albuterol makes her nasty and agitated) and I am soooo frustrated. Any suggestions of how to coax her in to cooperating?

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First I appreciate everyone's advice. We have gone back to the mask for now and are making it a game - better results the last few days. Just to be clear - we are not using albuterol but xeopenex. We are also trying to treat the cause as well - she is allergic to dairy, soy, tomato, pork, peaches, and cauliflower, thus we are in the midst of a major food change - eliminating soy and dairy is tough but we are getting the hang of the alternatives. In addition, dust mites, various molds, trees, etc. We are working to reduce the chemicals in our home, although I was fairly careful with her anyway - special detergent, shampoo etc. I am doing some reading and research to make sure all the bases are covered

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If you spent more time trying to find out what's causing her asthmatic symptoms than trying to chemically treat them - you may get better results. Might I suggest the ALCAT test? She's probably allergic to something in her everyday environment. Albuterol is dangerous & doesn't belong in the human body. I've been there & gotten past it. Research & get smart.

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If you spent more time trying to find out what's causing her asthmatic symptoms than trying to chemically treat them - you may get better results. Might I suggest the ALCAT test? She's probably allergic to something in her everyday environment. Albuterol is dangerous & doesn't belong in the human body. I've been there & gotten past it. Research & get smart.

When my daughter had to be on those for RSV, she was under 1yr but I just held the mist at her face and let her inhale it that way. She refused to wear the mask and of course wouldn't put or keep the tube in her mouth for it. At least if your daughter turns her head, she is going to get a face full of the meds in the air and that's better than nothing at all!! Or you could just hold the mask in front of her face but not put it on her and let her get it that way.

Good luck!
S.

These ladies pretty much have the medical aspect covered. Their advice is sound. For 5+ yrs. I worked with children and adults with disabilities. Predominantly autism and I tackled the toughest cases w/ the worst behavioral problems. The kids who sent 30 or 40 providers before me running for the hills. Most of whom had moderate to sever breathing problems and many of them having to be on a nebulizer as often as every 3 hrs. And they ALL fought me. The only thing I would add is that if you do decide to switch to the mask play with it first. Put it on & make it seem like loads of fun. Make silly faces, noises, ect. And don't let her play with it for awhile. You enjoy it in front of her and when she asks to play with it make it seem like it's your favorite toy and your making a sacrifice giving it up. You may even want to go as far as running the nebulizer w/H2O instead of meds while you wear the mask inhaling and exhaling in a very animated and silly way while performing a play for her. You can even incorporate puppets and take turns with the puppets using the nebulizer. Make sure the machine is running and this will get her to be accepting of the sound. There is a good chance she will begin to ask for her treatment because she now associates it with quality time with Mommy. Same thing goes for the mouth piece although since she is already familiar with it you don’t have novelty on your side. Leave pinning her down as a LAST resort. You want your baby to be able to breath but that will usually be more traumatic for her and cause her to have contempt for the machine. But if all else fails...do NOT feel guilty about pinning her down. Sometimes it has to be done although I am confidant that these approaches will work for you because it has yet to fail with the most terribly behaved of my prior clients. Good luck, best wishes, & hang in there!
~K.

I completely agree with everything Debbie said. The mask versus nozzle makes NO sense to me at all. Is this a pediatrician or an actual pulmonologist? We see a pulmonologist for my twin boys who both have asthma/allergies. I'm VERY familiar with the nebulizer. (We have the inhaler too which we use more mild cases.) We've only ever used the mask with the neb. They have ones that are smaller for a child. I would go back and demand the mask. Even if this doc is right that she would technically get more medicine with the nozzle (which I don't believe), it's kind of a moot point if she won't put the thing in her mouth to take the treatment!

As for the actual treatment, we turn on a cartoon or movie and then put the mask on. That usually worked for us. And worst case scenario, we would hold them still until they stopped fighting it. My doc always said this is something they HAVE to do. It's not optional like not eating your peas for dinner. LOL! But I can't imagine how you could force a child to put something in their mouth like that. Get the mask. It's way easier and you have more control over it.

(((HUGS))) It stinks to have a sick baby. I hope she gets better soon! S.

A couple of my kids had asthma pretty bad when they where young....and also hated the breathing treatments. Same result here, but kids doctor said using a mask is better than no treatment at all, so he had us loosely put tape over holes in the mask. (not covering the whole hole, just most of it.) He said if they fight the treatment after that it was fine because when they are fighting it they have to breath harder and deeper. I felt like I was abusing them to hold them in my lap and hold the mask over their faces...but after a while they quite fighting it and even got to the point where they would hold the mask on themselves. (much bribery and pleading later...LOL) I think at some point they got to realize they felt better after the treatment. I hope it gets better for you soon.

Ask your doctor to try the Xoepenex for her.

My daughter is 10 and has used Xoepenex since she was 2. When we moved here, the new pediatrician prescribed albuterol(generic/less expensive). She hated it! She said that it taste bad and it made her feel bad and cried when she had to take it. So I told the pediatrician to give me Xoepenx.

The brand name is a little more but Gabrielle has no side effects with it.
Hope this is helpful!

D.

We have a nebulizer, but we do natural treatments, not steriods. What I've done with colloidal silver in the nebulizer for a young one is use the pacifier attachment. When they are sucking on it, the hole where the air comes out is just under their nose. Perhaps try and find a pacifier attachment. Call the company of the nebulizer you have and ask them if they know where you can buy it. (Some is better than none.)

Do you mind me asking why she has to have steriods? If it's croup or congestion, there are other alternatives. If it's asthma...again other alternatives.

Good luck!

I guess at 16 months old, I would be horrified too! Sticking something in my mouth and really not understanding what it will do. Wow! What a bomber. Begin by asking her about it - what happens and why she's afraid. Most children will tell you. Then you place one on you and do it together. Remeber most children that age are great imitators of what they see their parents do.

Have you tried giving it to her when she is very relaxed, such as before she is about to fall asleep. Also keep the actual machine as far away from her as possible because the noise of the machine is what will scare her off. Also compliment her about how well she is doing and explain to her just how it is going to help her. Also if you have help say a nanny ask nanny to do it. Sometimes my kids cooperate much better for the nannies than they do for me.

Ask your Dr about an inhaler. My now 4 yr old has a nebulizer and we had the same problem with him our Dr proscribed the inhaler as an alternative to the nebulizer.

I was under the impression that albuterol had fallen out of favor for use in children. That being said, I know there is also a liquid form of albuterol. Have you tried this? It is known for altering children's behavior, in particular, for making them hyper. As I understand it, the drug is a derivative of adrenaline. Adrenaline is involved in the "fight or flight" response when animals are in danger. It increases the heart rate and opens up the lungs. In albuterol, they have isolated a chemical froma drenaline that causes the lung receptor to respond. Anyway, the "nasty" response from your daughter is not unusual. They have my 10 month old on xoponex and pulmicort every 4 hours for reactive airways and pneumonia. He doesn't like his treatment either, but actually prefers the mouthpiece to the facemask. My doctor told me they get more from the mask, but the place where we bought the nebulizer told us they get more from the mouthpiece. Either way, if it's not near their face, they don't get any of it, so I would just go with the mask. I don't think it makes that much difference.

Hi K.,

I was reading your post and I thought pretty much what anna thought in her post. Call the Dr or nurse and tell them you want the medication switched. Xoponex and pulmicort are great alternatives...and xoponex does not carry the agitation, increased heart rate, etc...side effects that albuterol does. You daughter may be refusing the treatment because of how it makes her feel. Not just to be stubborn. when you do get the meds switched, try using the face mask, so that you little one doesn't right away refuse the treatment. It may help some.

We had to do similar treatments every 4 hours for about a month when our daughter had RSV. We "bribed" her with her favorite movies to watch while we did the treatment. I can't say it worked 100%, but it definitely made the process MUCH easier.

Please go to www.Oxyphone.com to see a better way to give nebulizer treatments. Screaming does NOT increase the amount of nebs a child gets. There is lots of info on the website that debunks commonly held (but unsupported) rationale for the old way of giving nebs. The facebook site is http://www.facebook.com/pages/Davidson-NC/OxyPhone/270572.... My husband is an ER doctor who invented the Oxyphone for kids like yours. They use it in the ER all the time.

First, I don't get how putting the tube in the mouth is any different than using the mask -- the mask is merely delivery method -- it doesn't mean she gets less of the medicine in her lungs. Besides, if you put the tube in her mouth, the medicine is bound to end up more in her mouth (and tastes bad) than in her lungs where it does its work. I would ABSOLUTELY ask the pediatrician about that. It makes NO sense.

Second, I would go ahead and use the mask because, if she's fighting the tube put in her mouth, she's getting a lot less of the medicine than if you just use the nebulizer the way it was intended.

How in the world does anyone expect you to successfully get a 16-month-old to cooperate for the tube -- it's hard enough to get a small person to sit still for the entire duration of a nebulizer treatment the right way!

I SO don't get the tube vs. mask thing that I'm wondering if you misunderstood the directions. I would def. be talking to the doctor -- even if it's to say, "I'm using the mask because she's getting nothing using the tube. I want her to get at least some of the medicine in her lungs!"

BTW, just some ideas about the nebulizer in general: it's not fun to sit for the 20 or so minutes it takes to get an ampule of albuteral inhaled. The thing makes noise and it has to go on the face -- lots of reasons for kids to resist. She's old enough, I would just say, "This is a way to get medicine in your chest so you can breathe better" and put on a movie and sit her in my lap and not let her wriggle free. After a while, they give up trying to get away and just accept it. But that's with the mask... Also, don't be surprised, once you DO finally start getting the medicine delivered into her lungs (and therefore her bloodstream) if she's not a little cranky/agitated/"off" from the albuterol -- even changing from the inhaler to the nebulizer. And if he's put her on prednisone on top of it, you're in for a double-whammy. Whey don't you go to your pharmacy and talk to them about side effects etc?

Good luck!!!!!!!!!!!

I'm surprised the physician hasn't told you about a spacer. It's a chamber that connects the inhaler to a mouth peice that covers the childs mouth and nose. Press the inhaler and the child breaths in 6 times and repeat once. This ensures the child is getting all she needs from the inhaler. Most children don't inhale directly from the inhaler until they are 6yo old or so. Your childs pulmonologist should have sterile used chambers that he can give you if your insurance doesn't cover one.

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