Respiratory problems can be troublesome for a baby. Some are mild and can be treated with oral medications and vapor rubs. But some could need the medicine to be directly delivered to the lungs, for quicker and more effective results.
A nebulizer serves this precise purpose. Nebulizers are used for the treatment of several respiratory illnesses including chronic ones. But is the machine any helpful for infants and toddlers? MomJunction answers this question with a guide to nebulizers use for babies, the types of nebulizers, and the situations when an infant will require this device.
What Is A Nebulizer And How Does It Work?
A nebulizer is a device that converts liquid medicine into a fine mist that is inhaled and delivered across the respiratory system, to the lungs (1).
The nebulizer has three basic components: an air compressor, a medicine cup, and a mouthpiece or a mask – used for infants. Add a few drops of the medicine into the medicine cup, turn on the air compressor, and place the mask on the baby’s face to deliver the medicine in the form of a mist that can be inhaled.
A nebulizer thus allows the drug to reach parts of the respiratory system directly.
Are Nebulizers The Same As Inhalers?
No, they are different, although their primary function remains the same, which is delivering medicine in the form of inhalable mist. The following table lists the differences between nebulizers and inhalers (medical term: metered-dose inhalers) (2):
|Uses electricity to convert the medicine into a mist|
Recently a new nebulizer was launched that is very small and battery-operated.
|Needs no electricity|
|Can deliver any quantity of medicine||Delivers a small dose of medication at a time|
|It can be used with a wide variety of medicines||May not work with all types of medicines|
|Suitable for infants||Not suitable for infants, unless used with a spacer|
Inhalers require coordination between the press of the inhaler pump and inhalation. It means the baby needs to inhale at the same time as a parent presses the inhaler pump to release the medicine. It is nearly impossible for a baby to time their breathing. Thankfully, a device called a spacer can make the use of inhaler easy.
A doctor will decide what works best for the baby depending on the age of the baby, their medical condition, and the medicine to be delivered. Ultimately, nebulizers are more complex than inhalers, although you get more options with a nebulizer.
With the risk of COVID, doctors have been advising the use of a spacer rather than a nebulizer, because nebulizers cause more aerosolization and increase the risk of droplet spread and contamination.
Types Of Nebulizers
The following are the different types of nebulizers depending on how they create the mist:
- Jet nebulizer: It contains an air compressor with a motor that includes a piston. The piston moves to compress the air in a chamber. The compressed air then moves through the liquid medicine at a high velocity, which converts the liquid into a fine mist. Jet nebulizers are quite common in hospitals as they are inexpensive, and one pump can work multiple times.
- Ultrasonic nebulizer: A high-frequency ultrasonic wave vibrates a component, which is in contact with the liquid medicine. The rapid vibrations turn the drug into a mist. Ultrasonic nebulizers are silent and portable (due to battery power), but also expensive when compared to jet nebulizers. These nebulizers, however, produce smaller particles and therefore medication can penetrate deeper into the lung is smaller airways.
- Vibrating mesh nebulizer: These also use the ultrasonic wave technology, but evaporate the liquid better. Vibrating mesh nebulizers may increase the temperature of the medicine and may not be recommended for all types of medications.
- Mechanical nebulizers: It needs no power to operate. The user winds a spring at the bottom of the machine, and as the spring releases itself, it pressurizes the liquid and turns it into a mist. Mechanical nebulizers are seldom used.
The type of nebulizer needed depends on factors like the medicine, dosage, and frequency of medication. The next section tells you why an infant may need a nebulizer in the first place.
When Is Nebulizer Used For Babies?
A baby can need a nebulizer when they have the following conditions, which require delivery of the medicine into the respiratory system:
- Chronic respiratory conditions: Babies with genetic ailments that cause chest congestion can require repeated delivery of medication through a nebulizer. Examples of such conditions are asthma and cystic fibrosis (3).
- Lower respiratory system infections: Several respiratory tract infections, bronchiolitis infection (inflammation of the bronchioles), cause severe cough and cold. These conditions can require the delivery of medicine into the lungs through a nebulizer (4).
- Upper respiratory system infections: Nebulizers are also useful in administering medicine to the upper parts of the airways. A few examples are infections such as croup and epiglottitis, which affect parts of the throat namely the larynx and epiglottis (5).
A nebulizer can vaporize different types of medicine depending on the treatment required.
What Medicines Are Used In A Nebulizer?
A doctor can prescribe a wide variety of medicines for delivery through a nebulizer. These include antibiotics, airway relaxants, and corticosteroids to reduce inflammation. Adrenalin inhalations are used in a hospital setting for severe croup and airway obstruction. The baby can also inhale plain saline water mist to moist their airways when they are dry. Most doses of the medicine would be administered at home as per the doctor’s prescription. Therefore, parents must know the right way of using a nebulizer.
How To Use A Nebulizer With An Infant?
Follow these steps when administering medicine to the baby through a nebulizer:
- Wash your hands and collect all the things you will need – mask, medicine, dropper, the medicine cup, attachment tube, and the nebulizer machine itself. Place the device on a flat surface.
- Sit in a comfortable place and hold the baby on your lap in an upright position. Toddlers can sit by themselves.
- Give a book or a toy to keep the baby/toddler busy. It is important to prevent the little one from squirming while getting the medicine.
- Once the equipment and the baby are all set, connect the tube to the nebulizer and the medicine vaporizing cup to it. Use a dropper to add the prescribed quantity of medicine. If the medicine requires dilution with saline, then use another dropper to pour drops of saline into the medicine cup. Close the cup once the medicines are added. Hold the cup upright.
- Attach the mask to the nozzle on the medicine cup. Put the mask on to the baby’s face while the baby sits upright in your lap or is held upright in your arms.
- Turn on the nebulizer. The baby should breathe normally for five to ten minutes or for the time stated by the doctor. Keep the baby distracted by showing them their favorite toy or reading from a book. It will help them stay calm and breathe in properly and allow the entire medicine to reach the lungs.
- A nebulizer mask comes with straps that go around the face and keep the mask in its place. Nevertheless, hold the mask with your hand too, to prevent it from falling away accidentally.
- Once the dose has been administered for the required time, turn off the nebulizer.
- Remove the mask to end the procedure. If there is some mist still left in the cup, then let it out.
- Disassemble the tube, mouthpiece, and the measuring cup.
- It is important to note that you should attach the mask. Some people use the device without the mask, but delivering the treatment in this way leads to a waste of most of the medicine dose.
It is essential to clean the tube, mouthpiece, and medicine cup every time after using the nebulizer.
How To Keep A Nebulizer Clean?
You will only need to clean the mask/mouthpiece, and the medicine cup. There is no need to clean the tube every time but it needs needs cleaning every now and then. Parts of the nebulizer should be rinsed after every use and sterilized/disinfected once a week. Below are the steps to rinse and disinfect the nebulizer components:
- Separate the mask and medicine cup from the tube. If there are additional adapters or components for attachment of the mask to the medicine cup, then you need to rinse them as well. Store aside the tube and the nebulizer since they do not need cleaning. Also, remove the strap from the mask.
- Soak the mask, the medicine cup, and adapters in soapy water for 10-15 minutes. You can use standard dishwashing soap.
- Rinse the components preferably under warm water for 30 seconds before leaving them on a towel to air dry.
- Rinse the nebulizer parts. Submerge the components in a vessel of water and boil for 5-10 minutes. You can also sterilize in a microwave-based sterilizer that you use to disinfect baby’s bottles and pacifiers. An alternative is to sterilize in a dishwasher with a water temperature of 158ºC, for 30 minutes.
- If the nebulizer parts cannot be boiled, then you can use a solution of one part of distilled water and three parts hot water. Soak the components in it for one hour. Other alternatives are soaking in 70% isopropyl alcohol for five minutes and then in 3% hydrogen peroxide solution for 30 minutes. You can also use a solution of one part household bleach and 50 parts of water. Soak the components for three minutes.
- If you are using non-boiling methods for sterilization, then rinse the components under running warm water for a couple of minutes before leaving them to dry.
Avoid sterilization if the manufacturer does not specify it. Boiling and contact with disinfecting fluids may damage the nebulizer components if it is not designed for it. In such cases, clean and sterilize using the manufacturer’s recommended methods.
All the rinsed and sterilized parts of the nebulizer should be dry before their use. Assemble all the components and have a dry run of the nebulizer (without medicine) to remove any minuscule levels of moisture left inside it. Disassemble and store the parts in a clean and dry place.
Using the nebulizer with a baby can be a bit challenging. In the next section, we give you tips to get the most out of nebulizer usage for a baby.
Tips For Nebulizer Use With Infants
Here are some recommended best practices when using a nebulizer for an infant:
- Use the nebulizer at the same time each day. It will allow the infant to consider nebulizer use as part of their daily routine and hence they are less likely to resist using it.
- Do not use a nebulizer when the baby is upset or crying. They will not inhale adequate mist, and the medicine will get wasted.
- Create a friendly image of the nebulizer, especially for a toddler. Use words like “superhero mask” or “superpower mask” to make the little one feel more comfortable. Give a name to the nebulizer and allow the toddler to put stickers on it. It makes the nebulization session less of a treatment and more of an activity for the child.
- Make nebulizer time productive by reading books and playing a mini-game. Keep a toy exclusive for nebulizer time.
- Involve older toddlers in the process. Encourage them to hold their mask, switch on the machine, and watch how the mist forms within the medicine cup. It lays the foundation for self-use, which the toddler needs to do as they grow older.
A nebulizer is a useful medical device that makes several chronic respiratory problems manageable. Just like other medical equipment, nebulizers have also improved in design and functionality. Go through the owner’s manual before the first use of a nebulizer. Cleaning and regular maintenance are all that you will need to keep the nebulizer working for a long time.
Have something to share about nebulizers? Do tell us in the comment section below.
2. Inhaler or Nebulizer: Which One Should My Child Use?; Brenner Children’s Hospital
3. Managing CF; Stanford Medicine
4. Treating Acute Bronchiolitis Associated with RSV; American Academy of Family Physicians
5. Croup/Epiglottitis; The University of Chicago