What Is a Cough Assist Machine for Children?

Medically Reviewed by Dan Brennan, MD on July 30, 2022
6 min read

The ability to cough effectively is something many of us might take for granted. 

A lingering cough that carries on after a bout of flu might annoy you, but it’s also serving a crucial purpose. If your lungs function as they’re meant to, an effective cough clears your lungs and airway of mucus, viruses, and germs that are harmful to your health. A cough is one of your body’s lines of defense against these invaders.

Accidents and illnesses can leave some children unable to produce a proper cough. Things like rib injuries, neuromuscular diseases, or weak muscles might obstruct your child from coughing properly. A cough assist machine can help them to eject unwanted germs and intruders from the lung area by coughing more effectively. 

A cough assist machine helps you to cough by pushing air into your lungs and then pulling it out so you can cough properly. 

Cough assist machines can be a lifesaving intervention for a child whose lungs aren’t working to their full capacity. 

The standard way to measure if a cough is effective or not is by using a measurement called peak expiratory cough flow (PCF). It is also known as cough peak flows (CPF). 

Studies show that a normal range of CPF in children and teenagers aged 4 to 18 ranges from 147 to 488 liters/min or 162 to 728 liters per minute. 

The same study also showed that CPF in males tends to be higher regardless of age.

CPF in infants and young children is more variable. You can refer to your child’s pediatrician or family doctor if you notice any breathing or coughing abnormalities. 

In cases where a low CPF/PCF have been established, your doctor may recommend a cough assist machine for your child. 

Children usually need cough assist machines for the following reasons: 

Weak respiratory muscles. If you or your child has weak respiratory muscles, one main symptom is constant shallow breathing. Look for other signs like a weak cough and difficulty when yawning. 

Deformities in the upper chest. Some deformities in the upper chest area can have an impact on your child’s PCF. Severe cases of spinal curvature (scoliosis) or rigid spine syndrome (RSS) can affect a child’s ability to properly cough and breathe. 

People with tracheostomy tubes. Tracheostomy tubes are devices that are inserted through the throat and extend down to the lungs. These “trach tubes” help people breathe. They usually are used to assist children who have an airway blockage or other issue that impacts proper breathing. 

Injuries. Injuries to the ribs, brain, and spinal area can greatly affect your child’s ability to cough, which can delay healing and promote infection. 

Neuromuscular disorders. These disorders happen when the actions or growth of certain muscles are affected by the nervous system. Some kids or adults who suffer from them also have a hard time coughing properly. That leaves them vulnerable to infection, lung irritation, and long-term lung issues. 

Ultimately, being unable to cough can lead to breathing stress, repeating cycles of infection and lung obstruction, and even respiratory disease and lung failure. 

Several different companies make cough assist machines. Usually, the health care provider or a representative will show you how to use the model that was recommended to you. 

Standard cough assist machines settings are simple. There have three main functions: 

  • In breath. Also called inspiratory pressure, this setting pushes air inside your lungs to help you take a deeper breath. 
  • Out breath. The out breath, or expiratory pressure, then pulls the air out of your lungs, along with other secretions like mucus. 
  • Pause. There is a pause between breaths. Usually, the timing of the pause can be adjusted on the machine settings. 

Operating instructions can vary depending on the model. Your doctor will tell you how many times per day to use the cough assist machine and for how long. 

A standard treatment is usually four sets of five full breaths. Your doctor may have told you to complete more or fewer sets. You should always follow your doctor’s instructions.

If you’ve never used a cough assist machine before, you might need to start on a lower setting to get used to the airflow before you try using it at full power. Keep in mind that although a lower pressure may be more comfortable, it won’t be as effective. 

General cough assist machine instructions:

  1. Wash or disinfect your hands before you start. 
  2. Turn the power on.
  3. Begin with a practice breath set at a low airflow. Find the airflow pressure knob and start on the lowest setting. 
  4. Spend one second on inhalation, a one-second pause, and a one-second exhalation.
  5. Set the air pressure to +20 for inhale (inspiratory) and -20 for exhale (expiratory). Slowly increase the pressure to +40/-40 as you get accustomed to the machine. If your doctor has instructed you differently, though, always follow that advice. 
  6. Test the machine’s tube by removing the mask or plastic piece at the top and make sure the airflow is traveling both ways by holding it against the palm of your hand or another flat surface.  
  7. If your machine has a manual/auto switch, switch it to auto. 
  8. Put the face mask or mouthpiece over your nose and mouth. Make sure it’s airtight and that there’s no leakage. If there’s a leak, speak to your provider immediately because the machine won’t otherwise work as intended. 
  9. Try to work with the machine and inhale, then pause. Some mucus may come up. 
  10. As you exhale, the machine will pull air from your lungs. Try to work with the airflow and cough. 
  11. Complete a set of five full breaths. Take 30 seconds in between sets, then complete three more sets. 

Cough Assist for Tracheostomy Patients

Sometimes, children need to undergo surgery to insert a tracheostomy tube. This tube is inserted through the trachea in the throat area and goes down to the lungs. There are different reasons why people need to get these tubes. 

Usually, tracheostomy patients need to use a cough assist machine. They’re inhaling oxygen through their throats, bypassing the safety network of the nose and mouth. Debris and air pollutants can thus make their way into the lungs. 

The lungs protect and clean themselves by producing mucus. This mucus eventually needs to come out through coughing, or else it could cause infection and long-term issues in the lungs. That’s one reason why cough assist machines are essential to people with tracheostomy tubes.

An adapter for a tracheostomy tube is usually available with a cough assist machine. There is an inflatable cuff located on the end of the tube. This cuff needs to be inflated when you are using a cough assist machine and most other breathing devices. 

Talk to your healthcare provider about the best way to use a cough assist machine if your child has a tracheostomy tube. 

New Advances 

Recently, there have been cough assist machine prototypes made that vary from the standard models that require a power supply. These machines don’t need power to work. They’re operated by pumping with your foot. 

They’re not in the U.S. market yet, but their development indicates that steps are being taken in an exciting new direction that could enable people who use cough assist machines frequently to travel and experience newfound freedom. 

This innovation could also help people who live in remote areas of the world or people who suffer from frequent power outages. 

You need to wash the mouthpiece of your cough assist machine after every use. It could breed bacteria and germs if you don’t. 

  1. Use hot water and soap to wash your hands before your start. 
  2. Disconnect the mouthpiece and wash with hot water and dish soap, then set it out to dry on a clean towel. Do not put it in the dishwasher. 
  3. Make sure you wash it separately from household dishes to avoid spreading bacteria. 

You can wipe down or wash the rest of the machine: 

  1. Make a cleaning solution of hot water and mild soap or isopropyl alcohol. 
  2. Unplug the machine and wipe it down using a clean cloth and cleaning solution. 
  3. Wipe the face mask thoroughly. 

There is a bacteria filter on the machine. This piece can’t be washed. You should replace it if it’s blocked or air isn’t able to freely flow through. 

New cough assist machines cost anywhere from $6,000 to $12,000. Refurbished machines offer a more economical option with prices starting around $2,000. Wherever you choose to get your machine, make sure you’re getting it from a reputable seller. 

Health insurance may be able to help cover the cost. Be sure to check your coverage plan and speak to your healthcare provider.