Table 1.

A guide to age-appropriate airway-clearance techniques for children and adolescents with bronchiectasis or chronic suppurative lung disease.

Technique	Age range	Advantages	Disadvantages
Modified GAD or GAD	All age ranges	Suitable for infants and small children who are not yet old enough to cooperate with more active techniques	Discomfort, time consuming, symptoms of gastro-esophageal reflux or breathlessness, specific contraindications or precautions
		Option for those unable to use or too fatigued to use independent techniques
Percussion and vibrations	All age ranges	Suitable for infants and small children who are not yet old enough to cooperate with more active techniques	Passive, require assistant, discomfort, inconvenient, socially limiting
		Option for those unable to use or too fatigued to use independent techniques
Assisted autogenic drainage	Infants	Minimal equipment required	Requires assistance, difficult technique to master and for carers to learn
Bouncing on a fitball	Infant to toddler	Enjoyable for child	Equipment required
Blowing games	Toddler to child	Enjoyable for child
Huffing	Toddler to adolescent	Enjoyable for child
ACBT (includes huffing)	Toddler to adolescent	Independent, flexible, requires no equipment, can be combined with other techniques
Bottle PEP	Toddler to adolescent	Independent technique, enjoyable for child, can be a bridge to other forms of PEP therapy, minimal cost	Need to follow instructions to avoid swallowing water
Autogenic drainage	Toddler to adolescent	Independent technique, nil equipment required	Effect and feedback required to master the technique including sensitivity to auditory and vibratory cues of secretions
PEP mask	Toddler to adolescent	Independent technique, can be combined with other ACTs, beneficial for those with unstable or compliant airways	Infant PEP requires assistance. Requires individual awareness of breath size
			For younger children who are afraid of a mask, this may not be the technique of choice
			Cost
Mouthpiece PEP	Toddler to adolescent	Independent technique, can be combined with other ACTs, beneficial for those with unstable or compliant airways	No clear evidence on use of Mouthpiece PEP—either with or without nose clip Cost
		Can be used in conjunction with hypertonic saline nebulizer (see below)
		Easy for younger children to use
PariPEP™ with nebulizer	Toddler to adolescent	Independent technique, can be combined with other ACTs, beneficial for those with unstable or compliant airways	Cost
Flutter®	Child to adolescent	Independent technique	Effective use dependent on angle, therefore, may be more suited to an older child (8 years). Cost
Acapella®	Toddler to adolescent	Independent technique, can be combined with other ACTs, beneficial for those with unstable or compliant airways	Cost
		Not position dependent
Aerobika™	Toddler to adolescent	Independent technique, can be used in conjunction with nebulizer	Cost
Physical exercise	Toddler to adolescent	Enjoyable for child
HFCWO	Toddler to adolescent	Independent technique	Heavy device, not easily portable
			Cost

GAD, gravity-assisted drainage; ACBT, active cycle of breathing technique; PEP, positive expiratory pressure; ACT, airway-clearance technique; HFCWO, high-frequency chest wall oscillations.