American Academy of Pediatrics – Section on Pediatric Pulmonology and Sleep Medicine

Avoid administering nebulized medications by “blow by,” or placing the mask or nebulizer tubing near the child’s nose and mouth rather than securing the mask properly to the face. A t-piece with mouthpiece or face mask should be used instead.

There are many different formulations of asthma medications for pediatric patients. Accurate delivery of each medication to a pediatric patient is extremely important. There is a high rate of error by caregivers and, unfortunately, by health care workers in health care settings. Small children and infants are especially challenging. During a nebulizer treatment, a well-fitting, properly-placed mask to the face is required in a quietly breathing, younger patient who is not crying. An older cooperative child may use a t-piece with mouthpiece. If the drug being delivered can be converted to an inhaler, administered using a valved holding chamber with a face mask, this change should be considered. Finally, it is important to note that, if treatment failure is occurring with a nebulized inhaled steroid, it could be secondary to the family administering the medication using the “blow by” method by placing the mask or nebulizer tubing near the child’s nose and mouth rather than securing the mask properly to the face. Studies have shown that there is a 40% to 85% decrease in aerosol delivery when a mask is held 2 centimeters away from a child’s face while giving a nebulizer treatment.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.