Manual assisted cough method

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By the end of this chapter, you will be able to:

  • describe what manually assist cough method is and why it is used
  • demonstrate how to perform manually assisted cough for your child with a tracheostomy tube

The goal of the manually assisted cough method is to increase the force of air out of the lungs to assist your child’s cough and help them clear secretions. The manual assisted cough method involves pushing on your child’s belly just as they are trying to cough.

When should I use the assisted cough method?

You can provide a manual assisted cough after you have inflated the lungs using LVR or with a CoughAssist machine.

Always wait for your healthcare team to confirm that this method is suitable for your child before you start using it.

The manual assisted cough method is not suitable if your child has:

  • had a recent head or neck injury
  • had recent spinal surgery
  • bleeding in the lungs
  • fluid in the lungs
  • bronchopleural fistula
  • anxiety
  • an active resistance to or intolerance of position changes
  • a rib fracture or any other significant chest injury
  • a surgical wound near the area

How do I give a manual assisted cough?

  1. Child sitting upright in a chair

    Make sure your child is sitting upright and is comfortable. If your child is sitting on a chair, make sure it will not tip over.

  2. Child breath stacking with an LVR bag

    Have your child take a deep breath and hold it or you can stack breaths with an LVR bag (remove the bag before the child coughs).

  3. Heel of caregivers hand on child's abdomen above their belly button

    Place the heel of one hand on your child’s abdomen just above their belly button.

  4. Caregiver's other hand placed over first hand and fingers are interlocked and pulled away from the body

    Place your other hand on top of the first hand and interlock your fingers so that they are pulled away from the body.

  5. Keep your elbows straight.
  6. Push upward under the rib cage when the child coughs

    When your child coughs, push upward under the rib cage once. It may take practice to coordinate the push with the cough.

When should I use the manual assisted cough method?

The manual assisted cough method with LVR or CoughAssist should be done on an empty stomach on the following schedule:

  • before eating a meal
  • at least one hour after eating a meal
  • bedtime
  • first thing in the morning when your child wakes up


  • Stop the manual assisted cough method immediately if your child experiences:
    • nausea
    • vomiting
    • aspiration (for example has accidentally inhaled food)
    • headaches
    • muscle pain
    • pain in the ribs or spine

Remember, only use the manual assisted cough method if you are cleared to do so by your child’s health-care team. Talk to your child’s health-care provider and physiotherapist about a plan to reduce any possible risks to your child while helping them cough.

Last updated: November 10th 2023