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With the onset of infant screening for cystic fibrosis the diagnosis is most often being made before lung and digestive symptoms begin. In addition, new evidence is showing that lung disease often begins early in the life of a cf child. There may be no coughing, and x-rays may appear normal, but some preliminary studies have detected evidence of inflammation and air trapping in infants as young as 3 to 6 months of age. Air trapping occurs when air is able to enter the lung, but cannot get out of some areas because the airway opening is too small. This happens due to inflammation and/or infection and perhaps a build up of mucus in the tiniest of the bronchial airways. Because it seems that cf lung disease starts in the small airways and begins with air trapping, we recommend that chest pt begin very early in the life of a cf child, even prior to cough symptoms, to help eliminate, reduce and prevent air trapping. Since some evidence exists that head down tipping of infants in the typical postural drainage positions can lead to gastric reflux, therefore we no longer tip infants during chest physical therapy. Discuss this with your CF Center physician and healthcare team.
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Why is it so important to prevent air trapping? In some areas of the lung where air trapping occurs, the airway may eventually become totally blocked. Then air can no longer enter that portion of the lung and an area of collapsed lung occurs called atelectasis. Small areas of collapse can go undetected for a long time even though normal breath sounds are heard with a stethoscope. Routine x-rays can also be read as normal. If this small collapsed area is not re-inflated soon, inflammation and infection will continue causing permanent damage to the airway of the lung. This damage is in the form of an abnormally shaped, floppy and/or overly stretched airway which tends to produce excess mucus and can be a focal point for chronic infection. This is called bronchiectasis and it is not reversible. Since this damaging process seems to begin with air trapping, yet is difficult to detect in it's beginning stages, early treatment of infants with chest physical therapy for prevention would seem to be a good choice. We recommend chest physical therapy even for infants even prior to pulmonary symptoms. There seems to be no compelling reason to wait until a cough develops, yet much early damage may be prevented with chest physical therapy. |
| While there seems to be a very good medical reason to begin chest pt early in the life an infant with cystic fibrosis, there is also a quite practical one. This is the easiest time in the life of a cf patient to perform chest pt. It is also an easy time for parents to learn chest physical therapy, become involved in their child's care, establish good habits and routines, and fight back against this serious diagnosis. Chest pt for infants is not much more difficult for parents than burping a baby. Also, the infant receiving daily chest pt is more likely to grow into a toddler who has learned to accept the routine as a normal part of their day. This is a very important issue. Before infant screening the diagnosis of cf was most often made when a child became quite ill. In most cases it has been extremely difficult to begin to perform chest physical therapy with a two or three year old child who has not become accustomed to performing this treatment daily. Consider also that the child is not feeling well, that the parents are just learning the techniques themselves, and that they have the added pressure that their child's health relies upon their success in completing this new treatment. Attempts by parents to begin chest pt with their child after the child can walk have far too often been failures due to a kicking, screaming child. This unfortunate scenario prior to infant screening had no answer since most children need to become ill with cystic fibrosis symtoms before they were diagnosed. Infant screening can eliminate these horrendous situations for patients and parents. Yet, the scenario continues today if treatment waits for symptoms of a congested cough to develop at age two. Yet if chest physical therapy is begun in early infancy, and at the age of ten or twenty the patient with cystic fibrosis still has no symptoms of airway disease, will chest pt have been a waste of time - or will it have worked? Many parents who began early treatment hold the answer to that question in their hearts, and would not have accepted the risk of waiting longer to begin care. |
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