Humidified high flow nasal cannula (HHFNC) therapy factsheet
Introduction
When babies and children are unwell, they may have trouble breathing. Signs of breathing difficulty include:
- using extra muscles to breathe
- breathing faster than usual
- making grunting or wheezing sounds.
This is called respiratory distress. It can make their condition worse.
In the hospital, your child may be given humidified high flow nasal cannula (HHFNC) therapy to help them breathe. This therapy pushes pressurised and humidified air through your child’s nose to help open the lungs, making breathing easier and more comfortable.
Preparing for the treatment
Because HHFNC therapy happens in hospital, your child will be connected to monitors that check:
- heart rate
- breathing rate
- oxygen levels in the blood.
Your child’s treating team will explain the therapy and answer any questions you have.
During the treatment
Nasal suction
Some children will need nasal suction before starting HHFNC therapy. Children and babies make a lot of mucus when they are sick and are often unable to clear it themselves. Mucus can fill the nose, making it harder to breathe.
Your child’s nurse will place a small tube down their nasal passage to clear the mucus using suction. This should help their breathing get better.
Nasogastric tube
Your child may also need a nasogastric (NG) tube inserted before starting HHFNC therapy. This small tube goes down the nose and back of the throat to sit in the stomach. It helps remove any gas from the stomach that may have been swallowed during the HHFNC therapy. This makes your child more comfortable and helps them breathe better.
The tube may feel uncomfortable, and your child may cry or gag when it is inserted. It should not be painful.
Your child’s nurse will check that the tube is in the right place by removing and testing a small amount of stomach acid from the tube or using an X-ray.
Nasal prongs
Nasal prongs are placed in your child’s nostrils to deliver the warm, pressurised air. The Nasal prongs are the two small, straw-shaped endings on the end of a lightweight tube called a nasal cannula. One prong is inserted into each of your child’s nostrils.
The nasal prongs can move, so it is important to check they are in place and working. You can gently move them back into your child's nostrils or speak to your child's treating team for help.
After the treatment
Once your child’s breathing improves, the HHFNC therapy will be reduced slowly. Stopping it too quickly could make breathing worse.
Your child will stay in the hospital while having this therapy. The treating team will explain how long therapy will last, plan for slowly stopping HHFNC therapy and what happens after stopping.
Management
Eating and drinking during therapy
Always ask the treating team before giving food or drinks to your child. Some children will get fluids through their NG tube or an intravenous (IV) cannula in their arm to stay hydrated.
Comforting your child during therapy
HHFNC therapy can be unsettling and uncomfortable for your child. Even if they are unsettled, it is important that the nasal prongs stay in your child’s nose so the oxygen can be pushed through properly.
To help settle your child:
- swaddle smaller babies to comfort them
- hold older children if it’s safe
- bring favourite books, toys, or games for distraction
Once your child feels calm, their breathing should improve.
