Table 8: Recommendations for spirometry

in paediatric patients.44

1. Establish a patient-friendly environment

Greet the child, encourage conversation (compliment the way they are dressed, ask about holidays, school)

2. Use analogies to explain the test

Instruct the child to play a «blowing game» on the computer

Demonstrate the test by blowing into a handkerchief, blowing into a kerchief, blowing into a kettle, or blowing into a spittoon

3. Maintain correct patient position

Encourage the child to stand upright and hold the flow sensor vertically

Use nose clips, but if they are too uncomfortable avoid them

4. Encourage the patient to perform the manoeuvre properly

Position yourself at the same visual level as the child

Be expressive with your body language (change the intonation of your voice, use your hands)

Use words the child can understand and simple instructions: «Breathe in», «Breathe out»; «Breathe in until you feel like you’re bursting», «Breathe out»

Use visual incentives (such as birthday candles)

5. Train your frustration tolerance

Be prepared to try different techniques (open vs. closed manoeuvre)

Establish rest periods

Offer incentives (stamps, prizes, recognition)

Know when to stop. Sometimes it will not be possible to obtain technically acceptable or repeatable spirometry