Chest Physical Therapy (CPT) for Children Less Than 2 Years Old

These instructions from Children's Hospital of Philadelphia are for patients prescribed chest physical therapy (CPT).

Important information about Chest Physical Therapy (CPT):

CPT is a procedure that helps to loosen and move secretions in your child's lungs. These secretions may be coughed or suctioned out of your child's lungs.

CPT uses two methods: percussion and postural drainage.

Percussion is done by cupping your hands or using a percussion cup to focus on a specific part of the lung. Avoid performing CPT after a meal, as it may be uncomfortable for your child.

Postural drainage is done to allow parts of the lung to drain as your child moves into the different positions as shown in the photos below.

Instructions for performing CPT:

• Wash hands.

• Position your child as shown in the pictures below.

• Remove rings, watches or bracelets.

• Perform over one layer of clothing. Do not percuss on bare skin or over clothing with snaps or buttons.

• Use a percussion cup or your hands as shown below. Percuss the chest as instructed. Do not percuss over the spine, chest-bone or new surgical sites.

• Percussing should be firm, not painful. Hands should be cupped, not flat. You should hear a hollow clapping sound, not a sharp sound.

• Rest your hands for one minute after you clap each area. During this time, ask your child to take a deep breath and cough to move secretions out of their airways.

• If your child is unable to perform a cough, play blowing games with pinwheels or bubbles after each position to help with secretion clearance.

• If instructed, suction the secretions, as taught if your child cannot cough them up.

Make it fun!

CPT creates a time for caregivers and children to be together. It should not be a chore.

• Do CPT during a favorite TV show.

• Play music and sing together.

• Tell stories.

• Create a reward system to motivate your child to participate in the treatment.

• Teach friends or family members to do the airway clearance to help support you with your child's care.

Develop a routine:

Your child's health care team recommends that CPT be done every day on a schedule. Do the therapy before your child has a meal. It is encouraged to complete CPT more often if your child has an increased cough or increased secretions.

When to perform your child's CPT:

• In the morning to help clear out secretions collected during sleep

• Before bed to decrease nighttime coughing

• Other times as directed by the health care team

How long is a CPT treatment?

• Percuss for 2 minutes in each position on both sides for a total of 20-24 minutes. Use a timer to help you stay on track.

• Instruct your child, if able, to take deep breaths and cough after each position.

• When your child has appropriate head control, certain positions can be percussed on the right and left side at the same time for a total of 2 minutes to save time.

Positions needed for your child:

• All positions should be completed unless otherwise directed by the healthcare team.

• Order of positions is not important. The team suggests saving the positions your child likes the least for last.

Upper lobes

Position 1

Hold your child on your lap. Lean them forward at a 30-degree angle or hold your child up at your shoulder. Be mindful of supporting your child's head. Percuss on the right and left sides of your child's upper body.

Position 2

Hold your child on your lap. Lean your child back at a 30-degree angle. Percuss over their shoulder, between the collarbone and the shoulder blades. Percuss over the right and left shoulder.

Position 3

Position your child on their back, flat. Percuss between the collarbone and the nipple. Percuss on the right and left sides of your child's chest.

Middle lobes

Position 4

Lay your child on their side, slightly leaning back. Percuss just outside of the nipple area. Percuss on the right and left side.

Lower lobes

Position 5

Lay your child on their side. With your child's arm up over their head, percuss just below the armpit and over the ribs. Percuss on the right and left side.

Position 6

Lay your child on your lap on their stomach. Percuss over the lower ribs. Be sure not to clap below the rib cage or over the spine. Percuss on the right and left side.

If you have any questions or concerns, please call the Division of Pulmonary and Sleep Medicine.

Division of Pulmonary and Sleep Medicine

Reviewed on March 1, 2023, by Jacqueline Vicencio, PT; Joan Lloyd, RN