Breathing games for children with cystic fibrosis

This leaflet describes how to encourage your toddler in their chest physiotherapy sessions.

When your child reaches the ‘toddler’ stage, they are able to learn some breathing techniques that help to improve airway clearance. Making these sessions fun will help your child learn how to clear their lungs of secretions.

Breathing games can also be used with children of any age but should always be used in conjunction with any other airway clearance techniques as prescribed by your physiotherapist.

Why must my child do these ‘breathing games’?

The two aims of the ‘breathing games’ are to encourage your child to take bigger, deeper breaths and to learn how to breathe out in different ways. This will help to move and clear secretions from their lungs and increase ventilation.

Eventually, your child will learn how to huff and cough and learn the difference between shallow, deep, fast and slow breaths. This awareness of their breathing will help them to perform more formal breathing techniques to clear their lungs, which are taught by the physiotherapists when they are old enough to understand.

Learning about different breathing techniques also helps your child perform lung function tests correctly when they are old enough.

What about normal physical exercise?

Once your child is able to walk, run and maintain good balance, physical activity and exercise should also be encouraged. For example, jumping on a trampoline or a space hopper or playing wheelbarrows. Sporting activities should be included as they get older. This is because there is increasing evidence that physical activity not only improves and maintains a healthy level of fitness. It also helps to ventilate and clear the lungs of secretions too.

No matter how active your child is, it is beneficial that they drink plenty of fluids each day. Your dietitian can advise you on exactly how much fluid your child needs. This will keep them hydrated and help prevent the lung secretions from getting too thick and sticky, thus making it easier for your child to cough and clear their lungs.

Breathing games

The following is a list of breathing games that can be performed at any time of the day. However, they can be more effective if done during their physiotherapy. The games have been split into short and long breaths as it is important to teach your child how to do different types of breathing.

Short breaths

• Cotton wool balls: Place a cotton wool ball on your open, flat palm and ask your child to take a big breath in and then blow the ball off your hand. Alternatively, you and your child can hold a cotton ball each and blow the balls off together. Who can blow the ball the furthest? Repeat three or four times.
• Candle blowing: Under close adult supervision only, get your child to blow out a series of candles using a different breath for each candle
• Blowing apps: There are many different blowing apps for children that you can use on your Smartphone. Search for ‘Blowing games for children’ and choose one that you feel that your child would enjoy.

Long breaths

• Cotton wool balls and a straw: Place a cotton wool ball on a table and at one end place an open empty box on it’s side to make it into a ‘goal’. Then your child should take a big breath in and blow through a straw onto the ball to move it across the ‘pitch’ into the goal. As your child gets older you may want to participate with your child to make the game competitive. For example, who can score the first goal? Aim for your child to take four to five big breaths/blows in a game.
• Blowing onto a tissue: Hold out a thin tissue and ask your child to take a big breath in and blow onto the tissue to lift it up (if the tissue is too heavy, remove one or two ply-sheets). Repeat this three or four times. As their technique improves, encourage them to keep the tissue up for as long as possible, so that they exhale fully.
• Blowing bubbles: This is a firm favourite. To make it effective your child should take a big breath in and then gently blow out through an ‘O’-shaped mouth. Repeat for three or four ‘blows’. As their technique improves, encourage your child to breathe out for longer and more fully.
• Bubbling water: With a straw placed in a cup of water (half full only), ask your child to blow gently through the straw and make lots of bubbles in the water. Repeat three to four times.
• Blow painting: Place a few spots of paint on a piece of paper and then ask your child to blow into a straw as close to the paint as possible. This should ‘move’ the paint in different directions to make a picture. Warning: this may get messy!

Huffing games

Huffs can help move sputum up your child’s airway. To ‘huff’, you squeeze air out quickly from your lungs, out through your open mouth and throat, as if you were trying to mist up a mirror or your glasses. However, a young child will not be able to do this, so they can do huffs using the games on the next page.

• Huffing with tube: Using a small cardboard tube such as a peak flow mouthpiece, ask your child to blow through it with their lips closed tightly around it. You could make this into a game by putting cotton wool into the end of the tube and then get your child to blow it out as far as they can. This might be difficult for your child to understand and perform at first, so leave this game until they have mastered others and introduce it into their routine gradually.
• Huff with tissue: Once they have mastered the above huff technique then you can get your child to practice using a tissue. If you hold a tissue about 10 centimetres in front of your child’s face and then get your child to huff and try to blow the tissue away for as long as possible. It is important that your child huffs and not blows!

If you are experiencing any problems with these exercises or have any questions, please ask the physiotherapist (contact details below).

Toys and equipment

The following are additional toys which can also encourage your child to take bigger breaths in and out or to breathe harder (as in aerobic exercise), all of which help to mobilise and help clear secretions from the chest. They are not necessary if your child is active everyday and is doing the games suggested on this sheet. These are simply alternatives that may help to encourage your child, if they get bored or grow out of the other games:

• party bag whistles and blowing toys (available from large supermarkets)
• toy recorder/harmonica
• bird-sounding whistle
• polystyrene plane with a straw (available from toy/gift shops)
• paper windmill

It is recommended that the ‘blowing’ toys should not be shared with other children. They should be kept in a box marked ‘physiotherapy’, so that they are only brought out for play during these sessions.

Some toys/equipment can be used only once, for example, a straw or a tissue. Other toys can be kept clean by washing them in warm soapy water then rinsing with clean water and leave to dry naturally (alternatively, some toys may have cleaning guidelines attached to them so these instructions should be followed).

So that you know if the blowing games are being maintained and different ‘techniques’ are being learned (particularly if the supervising role is done by more than one person), it may be useful to keep a weekly record. An example of a table format is included in this leaflet which can be copied as many times as needed and changed to suit the games which are being done by you.

As a suggestion, a simple tick in the box could indicate that the particular activity had been done and ‘c’ for ‘cough’ could be added to indicate that your child needed to cough during or as a result of that activity.

Further information

If you have any questions or wish to discuss the information contained in this leaflet, please call the paediatric respiratory physiotherapist on 01223 216020.