Nebulizer/MDI for toddlers advice

[Guest915876]

Hi all,

I'm looking for advice from those with experience administering MDI/nebulizer treatments to toddlers. I've scoured the internet looking for resources but thought my best bet would be from those with actual experience!

Mostly looking for any recommendations to make life easier for those terrified 2 year olds who are fighting the nebulizer/MDI and for the parents/nurses attempting to administer the medication.

My patient today fought so hard that the provider eventually prescribed albuterol syrup (which I never knew existed honestly).

Any tips/info would be greatly appreciated.

[meanmaryjean, DNP, RN]

Bribery. A tablet / access to mom's phone which can ONLY be played with/ watched during treatments.

[OldDude]

Almost no one uses a nebulizer for simple albuterol delivery anymore. A facemask spacer and MDI is now used. The spacers have a one way valve in them where the kid can't exhale through it and expel the medicine so you don't have to teach them anything. You just have to make sure the facemask is sealed and your "treatment" goes from 15 minutes of screaming/fighting hell to a minute or two of that. AND...the MDI, when used with a spacer, is just as effective as a nebulizer treatment.

Good Luck.

[NotReady4PrimeTime, RN]

Almost no one uses a nebulizer for simple albuterol delivery anymore. A facemask spacer and MDI is now used.

That's quite a generalization. On my ICU we use more nebulized meds, especially for ventilated children, than we do MDIs. It's entirely physician-preference. And now, with the invention of the Aeroneb, it's super-simple to give nebs to kids on CPAP, BiPAP or fully vented.

[HiddencatBSN, BSN]

Almost no one uses a nebulizer for simple albuterol delivery anymore. A facemask spacer and MDI is now used. The spacers have a one way valve in them where the kid can't exhale through it and expel the medicine so you don't have to teach them anything. You just have to make sure the facemask is sealed and your "treatment" goes from 15 minutes of screaming/fighting hell to a minute or two of that. AND...the MDI, when used with a spacer, is just as effective as a nebulizer treatment.

Good Luck.

A lot of our patients still insist on the nebulizer because the perception is that it is more effective. So we do a lot of teaching about how with proper use the MDI is at least as effective and if the treatment is more tolerable, and therefore more likely to be administered correctly it can actually be more effective than a poorly given neb.

When bribery and distraction fails, place the child in the parent's lap on one leg. Parent crossed the other leg on top of the child's thighs. Patient is tucked in by the same shoulder as the leg they're sitting on so their back is to the armpit and side of the chest. That arm wraps around arms and holds the child and the other hand places the mask to the child's face. Parent can use the side of their face to help hold the child's head still against their shoulder. Hold the neb mask with a good seal or hold the MDI so that they can press the mask tight and activate a pump at the same time.

[HiddencatBSN, BSN]

That's quite a generalization. On my ICU we use more nebulized meds, especially for ventilated children, than we do MDIs. It's entirely physician-preference. And now, with the invention of the Aeroneb, it's super-simple to give nebs to kids on CPAP, BiPAP or fully vented.

I don't know if I would call that "simple albuterol delivery" if the patient is vented or on respiratory report. And IME when they ARE, patient cooperativity is usually less of a concern in administration.

[OldDude]

That's quite a generalization. On my ICU we use more nebulized meds, especially for ventilated children, than we do MDIs. It's entirely physician-preference. And now, with the invention of the Aeroneb, it's super-simple to give nebs to kids on CPAP, BiPAP or fully vented.

I said "simple albuterol delivery" in this case to toddlers who don't want to do it. There was no mention of ICU, vents, cpap, or bipap.