How do I do postural drainage?

There are several postural drainage positions. The different positions help drain mucus from different sections of the lungs. All people who have cystic fibrosis should do all the positions except babies, who should not be placed in the head-down position (“tipping”). Tipping a baby can cause reflux, which is when the contents of the stomach enter the esophagus.

Talk to your doctor or your respiratory therapist before starting PD & P. He or she can show you how the treatment is done and tell you how often and how long the treatment should be. Most doctors recommend that PD & P be done at least once a day.

PD & P is a time-consuming process. It usually takes 20 to 30 minutes. In general, a baby or small child who has no symptoms of congestion may require less treatment time than an older child who sounds congested and is coughing a lot.

At first, PD & P can seem complicated. But with help and practice, the treatment becomes easier, especially when you notice the benefits to your child. It is important to do these exercises exactly as instructed.

• Before you start, gather the materials you need, such as tissues, pillows, a thin cloth, or towels. If you have a baby or small child, you may sit in a chair with the child in your lap. If your child is older, he or she may be in bed using pillows for the different positions. You may need to experiment to find the best place to do the treatment so that both you and your child are comfortable.
• Position your child. Your doctor or therapist will recommend certain positions to use.
  • Upper lobes (back)
  • Upper lobes (front)
  • Lower lobes (side)
  • Lower lobes (back)
  • Lower lobes (front)
• Clap your child’s back or chest with your cupped hand quickly and rhythmically. This loosens the mucus, allowing it to drain. Do not clap directly on the skin—cover the area with thin clothing or a cloth. Bend your hand at the wrist and form a cup. When you clap, you should hear a hollow “popping” sound. If you hear a slapping sound, your hand is not cupped enough. You may safely clap over the ribs, but do not clap below the lower ribs or over the spine or female breasts. Follow this procedure for each position.
• How much force to use while clapping, and how long you clap, depends on the child. Consider the following:
  • Younger and smaller children require less force and time than older and larger children or teens.
  • Watch the child for signs of pain and discomfort. If you notice this, you may be using too much force.
  • Is your child congested but mucus isn’t coming up? If so, you may need to use more force.
• After clapping, apply vibrations. At the end of each position, you can vibrate the chest area to help loosen and move mucus. Have your child take a big breath and blow it out forcefully. As the child is blowing out, place your hand over the chest area and apply a little bit of pressure. Then quickly contract and relax your arm and shoulder muscles to produce vibrations throughout the chest area. To get the most out of this technique, ask your doctor or respiratory therapist to teach you how to do it properly. When your child is old enough, having his or her cooperation will make it easier to do this technique.
• After vibrations, have your child huff and cough. A huff is a forced exhalation that moves mucus higher and makes it possible to cough up more mucus. Huffing is best learned through demonstration, so ask your doctor or respiratory therapist to show you and your child how to do it. Huffing involves taking a deep breath and then breathing out forcefully, saying “huff.” Your child will do this 2 or 3 times before he or she coughs. If huffing is done well, you can actually hear the mucus moving upwards. Your child will spit out the mucus that comes up.