Desensitization tips for your child: non-invasive ventilation

Your child may have recently attended a respiratory clinic and have seen a respiratory doctor who has recommended your child have non-invasive ventilation (NIV) overnight. We are aware that for all children, getting used to wearing a ventilator and a mask overnight can sometimes be difficult. The aim of this resource is to offer some suggestions which may be helpful in getting your child used to the new equipment and making the process as stress-free as possible.

Mask establishment (daytime)

Although the ventilation therapy is for night time use, it can often be beneficial to get used to the mask and the ventilator in the daytime first.

The advantages of daytime use are that both you and your child are fully awake and have higher tolerance levels. It is also less frightening for your child and less stressful for you to slowly introduce the mask and the ventilator in a calm setting that does not alter or affect a night time routine. Being able to wear the mask during the day while awake means that your child will be more likely to wear it at bedtime.

How to introduce a ventilator mask

1. Find a quiet space away from too many distractions, and if possible practice the mask establishment at the same time each day.
2. Agree a maximum duration of time per day with your child (a 30 minute block is a recommended duration).
3. At first, hold the mask on your child’s face for 1 minute. Then encourage your child to hold the mask themselves if they wish to. Repeat this process as often as you can in the 30 minute block, but do not exceed a minute at a time to begin with.
4. Try to slowly build up the amount of time your child is comfortable wearing the mask. It may be beneficial to use distractions such as watching TV or playing games to increase mask time. The aim would be for your child to eventually wear the mask for a 30 minute undisturbed block.
5. Once your child is comfortable wearing the mask for 30 minutes, the next step is to connect the NIV (non-invasive ventilation) machine to the mask and try some air through the mask.

Ventilation introduction (daytime)

1. Let your child get used to the noise that the ventilator makes. Turn the machine on and leave it running in the background whist doing other things.
2. With the tubing connected and the machine turned on, let your child play with the airflow. Your child might speak into the airflow, pretend the air flow is a hair dryer or blow air into their face.
3. Repeat the steps 1 to 4 as listed above, but with the ventilator on and air blowing through the mask. Do this until your child can tolerate it for at least 5 minutes.
4. If your child is young enough to still have a daytime nap, consider using the machine and the mask when they fall asleep in the daytime. This will get them used to the feel of the ventilation for a shorter duration and help prepare them for overnight ventilation.

Ventilation introduction (night time)

It is important that your child recognises that they will be using the machine overnight so it is beneficial to make it part of the bedtime routine.

Make sure that the ventilator is kept visible in the bedroom when not in use. This will let your child get used to seeing it in that environment and become familiar with it.

If possible, make the ventilator part of the bedtime routine. For example: after cleaning teeth, settle your child in bed wearing the ventilator and mask whilst you read them a story. If your child is able to fall asleep with the ventilator on then they will become more used to it and more likely to wear it all night.

It is not uncommon for your child to pull the mask off in the middle of the night. Hopefully this will only be a problem for the first few weeks. If this happens it is recommended to check on your child and replace the mask if it has been removed. Your child will eventually become used to the mask and wear it through the night.

Aim for 3 to 4 hours of night time sleep for a few nights.

Tips that may help with introduction

• only use positive reinforcements or rewards for any attempts your child makes
• use favourite video games, TV shows, toys, books and music to help with distraction
• during the day, work toward wearing the mask for longer periods by rewarding your child with something they like
• throughout the process, talk to your child about the ventilation while putting on the mask or getting ready for sleep
• talk about why they need to wear the mask and what it does. Explain the parts of the machine and help them feel informed.
• let your child examine the mask and machine. Answer any questions your child may have.

Other tips to help your child get familiar with the mask

• put the mask and headgear on a teddy bear or doll
• for older children, you may have your child put the mask and headgear on you and let your child adjust it
• you may also wish to give your child a doll or stuffed animal that wears a mask then have your child try it on themselves
• get masks or silly noses for family members to wear, such as toy animal noses, clown noses or a small plastic cup. Wear a mask or silly nose when your child is wearing the mask and getting ready for bed.
• give your child jobs related to the CPAP (continuous positive airway pressure) machine that they can help with. This might include holding the mask while you put on the straps, turning on the machine or helping you clean the mask.
• encourage your child to pretend to be a jet pilot, astronaut, firefighter or scuba diver wearing a mask
• read a book about firefighters or other people who wear masks or watch age appropriate superhero or wrestling movies where the stars wear masks
• colour in a colouring book that features masks, encourage your child to draw pictures of people wearing masks, or to draw masks on pictures of children or animals in colouring books
• make masks for other family members to wear as an activity together