In this short video, we show you how to help your child use a spacer without a face mask using two different breathing techniques:
- tidal breathing or multiple breath technique
- single breath and hold technique.
We have a different video if you’re helping a child use a spacer with a face mask.
This inhaler is a pressurised metered dose inhaler (pMDI). It’s sometimes called a ‘puffer’.
It’s best to use a spacer with a pMDI inhaler because it helps get the right amount of medicine into your child’s lungs. Using a spacer can also prevent side effects from steroid medicines in preventer or combination inhalers.
Expert advice for using a spacer without a face mask for a child
Hi, I'm Sonia, a respiratory physiotherapist.
Using a spacer when helping a child use an inhaler means more medicine gets down into their lungs. It's a great way to help manage their symptoms.
Getting the technique right is very important. It may take a few tries to feel comfortable giving the medicine this way, but it gets easier with practice.
If you're helping a child use a face mask with their inhaler and spacer, watch our other video.
There are two different breathing techniques a child can use:
Tidal breathing technique
I'll first show you 'tidal breathing'. If their healthcare professional has recommended 'single breath and hold' technique, we'll show you that next.
To use the inhaler:
1. Hold it upright and take off the cap.
2. Check there's nothing inside the mouthpiece.
3. If the spacer has a valve, make sure the valve is facing upwards.
4. Shake the inhaler well [you can leave the inhaler in the spacer while you shake it].
5. Put the inhaler into the hole at the back of the spacer.
6. If the spacer has a cap, take it off.
7. Ask your child to sit or stand up straight and slightly tilt their chin up, as it helps the medicine reach the lungs.
8. Ask them to put their lips around the mouthpiece of the spacer to make a tight seal and begin breathing in and out [through their mouth].
9. Press the canister on the inhaler once and encourage them to breathe in and out slowly and steadily [through their mouth] into the spacer five times.
Single breath and hold technique
If their healthcare professional has recommended 'single breath and hold' technique, here's what they mean.
1. Encourage your child to breathe out gently and slowly [through their mouth] away from the inhaler and spacer until their lungs feel empty and they feel ready to breathe in.
2. Ask them to put their lips around the mouthpiece of the spacer to make a tight seal.
3. Press the canister on the inhaler once.
4. And have them breathe in slowly and steadily [through their mouth] until their lungs feel full.
5. Take the mouthpiece of the spacer out of their mouth
6. With their lips closed, ask them to hold their breath for up to 10 seconds or for as long as they comfortably can.
7. Then have them breathe out gently [through their mouth] away from the spacer and inhaler.
8. Finally, if your child has been prescribed a second puff, with the inhaler and spacer away from their mouth, wait 30 seconds to a minute.
9. Shake the inhaler again, then repeat steps (1 to 7).
10. When you've finished, take the inhaler out of the spacer and replace the caps on the inhaler and the spacer.
If your child is using a small volume spacer, some of them make a whistling sound if they are breathing in too fast.
If they are using a large volume spacer like this one, the breathing techniques are the same.
With tidal breathing, the spacer should make a clicking sound as they breathe in and out [through their mouth].
If your child has used an inhaler that contains steroids, make sure they rinse their mouth out with water or brush their teeth to avoid side effects.
Remember, you can get more top tips on helping your child use their inhalers by watching our other videos.
Call 999 if:
Your child is having an asthma attack or flare-up of their lung condition, and their reliever inhaler is not helping.
Check your child's inhaler technique
Helping your child use the right inhaler technique with their spacer will help them breathe the medicine straight into their lungs, where it’s needed.
This will help your child:
- manage their symptoms without needing to take a higher dose of their medicine
- reduce their risk of having an asthma attack or flare-up of their lung condition. The medical word for this is exacerbation.
- manage their usual triggers better
- reduce their side effects
- make their medicine last longer
- sleep better
- take part in exercise or other activities.
It’s important to watch your child take their inhaler so that you know they’re using it properly.
You can also ask your GP, nurse or pharmacist to check your child’s inhaler technique. Remember that you do not need an appointment to get help from a pharmacist at your local pharmacy.
Check that your child is using the right spacer
As your child grows, the size of their spacer will need to change. Using the right spacer for their size and development will help your child get the full dose of their medicine.
If your child is over five years old, they should try using a spacer without a face mask. This is because the medicine can stick to your child’s face or the inside of the face mask.
You can ask your child’s GP, nurse or pharmacist to check that they’re using the right spacer for their age and size.
Tips to help your child use their inhaler and spacer correctly
Some inhalers need to be shaken well before each use. This includes pressurised metered dose inhalers (pMDIs) and breath-actuated inhalers (BAIs). Four or five times is ideal.
This helps to make sure the medicine and the gas that create pressure in your child’s inhaler (called a propellant) mix properly.
If you’re not sure whether you need to shake your child’s inhaler, check the Patient Information Leaflet (PIL) that comes with their inhaler or speak to a healthcare professional.
Testing your child’s inhaler usually means checking if you can see medicine coming out without them inhaling it. It’s important to check that your child’s inhaler is working properly to make sure they get the right amount of medicine to their lungs.
You should test a pMDI inhaler if your child has not used it for a few days, or they're using a new one for the first time. You do not need to test your child’s inhaler before every use.
The Patient Information Leaflet (PIL) that comes with your child’s inhaler might also tell you how often you should test their inhaler. Ask a healthcare professional if you’re not sure or have any questions.
To check how to test your child’s inhaler, check the PIL or ask a healthcare professional. You might test the inhaler by taking the cap off, pointing the mouthpiece away from you and your child, and pressing the canister to release a puff into the air.
Help your child sit or stand up straight. If this is too difficult, sit your child on your lap, either sideways or facing away from you.
Help your child lift their chin slightly and hold the inhaler upright. This helps the medicine reach your child’s lungs, where it’s needed.
If you have a baby or young toddler, they may find it easier to use a face mask. Learn more about using a spacer with a face mask.
Before using their inhaler, your child should breathe out as far as they can through their mouth. This will create more space in their lungs.
They can then take a full breath in through their mouth when using their inhaler.
If your child can hold their breath for 10 seconds after using their inhaler, it will help the medicine to settle in their lungs. They should only hold their breath for as long as they feel comfortable.
Waiting between each puff gives the medicine and gas (called a propellant) enough time to mix back together after being shaken.
Some preventer inhalers and combination inhalers, like Maintenance and Reliever Therapy (MART) and anti-inflammatory reliever (AIR), contain steroid medicine.
The steroid medicine can build up on the back of your child's throat, mouth and tongue and cause side effects including:
- a hoarse voice
- cough
- sore throat
- a mouth infection called oral thrush.
If your child can rinse their mouth with water and spit it out after using their inhaler, it can help to clear the medicine. This can help reduce the chance of these side effects.
When using a face mask, the medicine can stick to your child’s face. Wiping your child’s mouth after they use their inhaler can help prevent a mouth infection.
Getting your child into a good medicine routine
It’s a good idea to support your child to get into a regular medicine routine.
They will need to take their preventer inhaler every day as prescribed, even if they’re feeling well. You should watch them to make sure they’re taking their medicines correctly.
Having a regular routine can help you and your child remember to use their inhaler and spacer. Learning this will help them manage their asthma more independently when they’re old enough and feel ready.
Try these top tips to help your child get into a good medicine routine:
- Keep their preventer inhaler and spacer or face mask on their bedside table to remind them to take it when they wake up and just before going to sleep.
- Ask your child to put a sticker on their toothbrush as a reminder. Research shows you’re more likely to remember to take your medicine every day if you link it to something you already do, like brushing your teeth.
- Make it fun so that your child links taking their inhaler with something positive. This can also help your child to feel more comfortable with taking their inhaler. Some parents have told us they find it helpful to decorate their child’s inhaler or spacer with stickers, give the inhaler a character name, do a special handshake or fist bump after each time they take it, or make doing a silly dance together part of the routine.
- Set yourself reminders on your phone or write yourself a note in your diary or in your calendar. This can be useful if you’re away from home too.
- Ask family or friends to help remind you and your child. This might be useful if your child has recently started using an asthma inhaler. If your child has siblings who are old enough to help, it’s a good idea to teach them about asthma too.
Help your child feel comfortable with their inhaler and spacer
We know from calls to our helpline that it can be difficult to get your child to use their inhaler and spacer. Using an inhaler and spacer might feel like a scary and unfamiliar experience for them. It’s normal that this can sometimes lead to emotional reactions.
It might take some time for your child to feel comfortable with taking their medicines, but it does get easier with practice.
If your child’s inhaler and spacer are still not working well for them, or they're not comfortable with their devices even after trying them for 8 to 12 weeks, talk to a healthcare professional.
If your child does not want to use their inhaler and spacer, you could try to reassure them by pretending to take the medicine yourself or pretending to give it to their favourite toy.
Helping your child get into a good medicine routine can also make them feel comfortable with their medicines.
We also have more tips on how to help young babies use a spacer and a face mask.
Disclaimer
This video is not a replacement for professional medical advice. If you’re finding it hard to use your inhaler or you’re worried about your symptoms, please speak with a healthcare professional.
Your GP, nurse or pharmacist can check your inhaler technique. Remember that you do not need an appointment to get help from a pharmacist at your local pharmacy.
Always read the patient information leaflet inside your medicine packet. It tells you more about your medicine, including all the possible side effects and how to store the medicine safely. Speak to your GP, nurse or pharmacist if you have any questions.
Asthma + Lung UK does not endorse or recommend specific products. Read more about how we create our health advice information.
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