How to Find Child-Friendly Spacers

by

Finding the right spacer for a child’s respiratory medication is a crucial step in managing conditions like asthma effectively. A well-chosen spacer ensures that the medicine reaches the lungs where it’s needed most, minimizing side effects and improving overall treatment outcomes. This guide cuts through the noise, providing a definitive, practical approach to selecting, using, and maintaining child-friendly spacers.

Why a Spacer is Non-Negotiable for Children

For children, especially those under five, using a metered-dose inhaler (MDI) directly is largely ineffective. The rapid spray often impacts the back of the throat or mouth, leading to less medication reaching the lungs and a higher risk of oral thrush or irritation from steroid medications. Spacers, also known as valved holding chambers (VHCs), create a holding area for the medication. This allows the child to breathe in the medicine slowly and deeply over several breaths, maximizing lung deposition. It transforms a quick, often poorly coordinated, puff into a more controlled and effective delivery system.

The Essential Criteria: What Makes a Spacer “Child-Friendly”?

A child-friendly spacer isn’t just a smaller version of an adult one. It incorporates specific design features and functionalities that cater to the unique needs and developmental stages of children.

1. Age-Appropriate Mask vs. Mouthpiece

This is the most critical distinction.

  • For infants and young children (typically under 5 years old): A spacer with a face mask is essential. Young children cannot reliably form a tight seal around a mouthpiece or coordinate their breathing with the inhaler puff. The mask ensures the medication is contained and inhaled, even with irregular breathing patterns.
    • Actionable Tip: When choosing a mask, look for one made of soft, flexible silicone that can form a good seal around your child’s nose and mouth without causing discomfort or leaving red marks. A transparent mask allows you to see if the child is breathing in the medication correctly and if the valve is moving.

    • Concrete Example: If your child is a toddler, opt for a spacer like the AeroChamber Plus Flow-Vu with a small infant mask. The Flow-Vu indicator provides visual confirmation of inhalation.

  • For older children (typically 5 years and above): As children develop better coordination and can follow instructions, they can often transition to a spacer with a mouthpiece. This generally allows for even more efficient drug delivery.

    • Actionable Tip: Practice with your child to ensure they can create a tight seal around the mouthpiece and inhale slowly and deeply.

    • Concrete Example: For a school-aged child, a spacer such as the Volumatic or Able Spacer with a mouthpiece might be suitable. Ensure it’s comfortable for them to hold and seal their lips around.

2. Valved Holding Chamber (VHC) Functionality

Not all spacers are created equal. A “valved holding chamber” (VHC) is superior to a simple spacer tube.

  • One-Way Valve: A VHC has a one-way valve that holds the medication in the chamber until the child inhales. This prevents the medication from escaping and gives the child more time to inhale the full dose.
    • Actionable Tip: When examining a spacer, look for a visible valve within the chamber. Some VHCs even have a “flow-vu” or “flow-signal” indicator that moves as the child breathes, offering visual feedback that they are inhaling properly.

    • Concrete Example: The AeroChamber Plus Flow-Vu features a small flap inside that visibly flutters with each breath, confirming medication inhalation. This is invaluable for parents and caregivers.

3. Material and Durability

Children are active, and their medical devices need to withstand daily use.

  • Durable, Shatter-Resistant Plastic: The spacer should be made from robust, medical-grade plastic that can withstand accidental drops without cracking or breaking.
    • Actionable Tip: Physically inspect the spacer. Bend it slightly (if possible without damage) to gauge its flexibility and resistance to impact. Avoid brittle plastics.

    • Concrete Example: Many reputable brands use high-quality, shatter-resistant polycarbonate or polypropylene.

4. Ease of Cleaning and Maintenance

Proper cleaning is essential to prevent bacterial growth and ensure optimal performance.

  • Simple Disassembly: The spacer should be easy to disassemble into its component parts (chamber, mask/mouthpiece, adapter) for thorough cleaning.
    • Actionable Tip: Before purchasing, ask the pharmacist or check the packaging for cleaning instructions. Can you easily take it apart and put it back together?

    • Concrete Example: Most spacers recommend soaking in warm, soapy water (mild dish detergent) and air-drying. Look for smooth surfaces and minimal crevices where dirt or residue could accumulate. Avoid spacers that require complex cleaning tools or procedures.

5. Compatibility with Inhalers

Not all spacers fit all MDIs.

  • Universal or Specific Fit: Some spacers are designed to be universally compatible with most standard MDIs, while others are brand-specific.
    • Actionable Tip: Always bring your child’s prescribed MDI with you when purchasing a spacer to ensure a snug fit. The MDI should fit securely into the spacer’s adapter port without being too loose or too tight.

    • Concrete Example: If your child uses a Ventolin MDI, ensure the spacer explicitly states compatibility or test the fit directly.

6. Portability and Size

While less critical than functionality, portability can influence compliance.

  • Compact Design: A compact and lightweight design makes it easier to carry the spacer in a school bag, backpack, or emergency kit.
    • Actionable Tip: Consider how often and where your child will need to use the spacer. If it’s for daily use at school, a more portable option is better.

    • Concrete Example: Smaller volume spacers generally offer better portability, but ensure they don’t compromise on effective drug delivery.

7. Low Electrostatic Charge

This is a technical but important feature. Electrostatic charge can cause medication particles to stick to the inside of the spacer, reducing the amount inhaled.

  • Anti-Static Materials: Many modern spacers are made from anti-static materials or treated to minimize static.
    • Actionable Tip: While difficult to verify by inspection, checking product descriptions or asking your healthcare provider about anti-static properties is beneficial. Proper cleaning (soaking, not wiping dry) also helps maintain anti-static properties.

    • Concrete Example: Spacers that recommend air-drying without rinsing (to leave a thin film of detergent) are often designed to reduce static.

The Purchasing Process: Where and How to Buy

Navigating the market for medical devices requires a systematic approach.

1. Consult Your Healthcare Provider First

Before you even think about purchasing, consult your child’s pediatrician, pulmonologist, or an asthma educator.

  • Prescription and Recommendation: They will recommend the most appropriate type and brand of spacer based on your child’s age, specific respiratory condition, and the type of inhaler prescribed. Some spacers may require a prescription for insurance coverage.
    • Actionable Tip: Ask for a specific brand recommendation and a demonstration of how to use it with your child’s inhaler. Inquire about having a “spare” spacer.

    • Concrete Example: Your doctor might specifically recommend an “AeroChamber Plus Flow-Vu with a pediatric mask” for your 3-year-old with asthma.

2. Explore Reputable Pharmacies and Medical Supply Stores

These are the primary sources for medical-grade spacers.

  • In-Person Purchase: Buying in person allows you to physically inspect the spacer, check for damage, and ensure the inhaler fits correctly. Pharmacists can also offer guidance.
    • Actionable Tip: Visit a well-stocked pharmacy or a medical supply store that specializes in respiratory care products. Avoid generic or unbranded options.

    • Concrete Example: Go to a large chain pharmacy like CVS or Boots, or a dedicated medical supply store in your area.

3. Online Retailers with Caution

While convenient, exercise caution when buying online.

  • Authorized Sellers Only: Purchase only from authorized online retailers or the manufacturer’s official website to avoid counterfeits or products that don’t meet health standards.
    • Actionable Tip: Check reviews, but also verify the seller’s legitimacy. Look for return policies and warranty information.

    • Concrete Example: If buying from Amazon, ensure the seller is “Shipped and Sold by Amazon” or a recognized medical supplier. Avoid unknown third-party sellers.

4. Check for Certifications and Standards

Reputable spacers will meet certain health and safety standards.

  • FDA Approval/CE Mark: In many regions, medical devices require specific approvals. Look for FDA approval (in the US) or a CE mark (in Europe) to ensure the product meets safety and quality standards.
    • Actionable Tip: This information is typically found on the product packaging or the manufacturer’s website.

    • Concrete Example: The packaging clearly displays “FDA Approved” or the CE logo.

5. Consider the Cost and Insurance Coverage

Spacers vary in price, and insurance coverage can differ.

  • Prescription vs. Over-the-Counter: Some spacers are available over-the-counter, while others require a prescription and may be covered by insurance.
    • Actionable Tip: Discuss coverage with your insurance provider before purchasing. A prescription might significantly reduce your out-of-pocket costs.

    • Concrete Example: If your insurance covers medical devices, getting a prescription for the spacer could mean you only pay a co-pay instead of the full retail price.

Mastering the Use: Practical Application

Having the right spacer is only half the battle; knowing how to use it correctly is paramount for effective treatment.

1. Read the Manufacturer’s Instructions Thoroughly

Every spacer model has specific usage guidelines.

  • Step-by-Step Guide: Before the first use, carefully read and understand the instructions provided by the manufacturer.
    • Actionable Tip: Keep the instructions handy for reference, especially in the initial days of use.

    • Concrete Example: The instructions will detail assembly, how to attach the inhaler, and specific breathing techniques for optimal delivery.

2. Proper Assembly and Inhaler Attachment

A secure connection is vital to prevent medication leakage.

  • Firm Connection: Insert the MDI mouthpiece firmly into the spacer’s adapter. It should fit snugly without being forced.
    • Actionable Tip: Practice assembling and disassembling the spacer a few times to get comfortable with the process.

    • Concrete Example: Push the MDI into the rubber opening at the back of the spacer until it feels secure and doesn’t wobble.

3. Administering Medication with a Mask (for young children)

This technique requires patience and a good seal.

  • Positioning: Sit your child comfortably upright. Place the mask over their nose and mouth, ensuring a tight seal without gaps.

  • Puff and Breathe: Press the inhaler once to release a puff of medication into the spacer. Keep the mask firmly in place for 5-6 breaths (or as directed by your healthcare provider).

    • Actionable Tip: Count the breaths aloud to ensure the correct number. Watch for the valve movement (if present) to confirm inhalation.

    • Concrete Example: “Okay, let’s take five slow breaths. One… two… three…” Maintain a calm demeanor to reassure your child.

4. Administering Medication with a Mouthpiece (for older children)

This technique focuses on coordinated breathing.

  • Positioning: Have your child sit or stand upright. Instruct them to exhale fully away from the spacer.

  • Seal and Inhale: Place the mouthpiece in their mouth, ensuring their lips form a tight seal around it. Press the inhaler once to release a puff. Immediately, have your child breathe in slowly and deeply through their mouth until their lungs are full, then hold their breath for 5-10 seconds (or as long as comfortable).

    • Actionable Tip: Emphasize a slow, deep breath, not a quick gasp. If the spacer has a whistle, they should aim to avoid it by breathing slowly enough.

    • Concrete Example: “Breathe all the way out, then take a big, slow breath in like you’re smelling a flower, and hold it… now slowly out.”

5. Multiple Puffs

If multiple puffs are prescribed, follow a specific protocol.

  • Wait and Repeat: For each additional puff, remove the MDI from the spacer, shake the MDI again, reinsert it into the spacer, and repeat the administration steps after a short wait (typically 30 seconds to 1 minute, as per medication instructions).
    • Actionable Tip: Do not put multiple puffs into the spacer at once, as the medication can settle on the walls of the chamber.

    • Concrete Example: After the first puff and breaths are complete, detach, shake, reattach, then administer the second puff.

6. Post-Medication Rinse (for steroid inhalers)

Crucial for preventing oral side effects.

  • Rinse and Spit: If the inhaled medication contains corticosteroids, have your child rinse their mouth thoroughly with water and spit it out immediately after use. Younger children can drink a small amount of water.
    • Actionable Tip: Do not let them swallow the water, as this defeats the purpose of rinsing.

    • Concrete Example: “Now, let’s gargle with this water and spit it out to wash away any medicine in your mouth.”

Sustaining Efficacy: Cleaning and Replacement

Proper care ensures the spacer remains effective and hygienic.

1. Regular Cleaning Schedule

Consistency is key to preventing buildup and maintaining performance.

  • Weekly Cleaning (or as per manufacturer): Most spacers should be cleaned at least once a week, or more frequently if used daily.
    • Actionable Tip: Set a reminder on your phone or mark it on a calendar to establish a routine.

    • Concrete Example: Every Sunday evening, make cleaning the spacer part of your child’s routine.

2. The Correct Cleaning Method

Avoid methods that can damage the spacer or introduce static.

  • Soak, Don’t Scrub: Disassemble the spacer. Soak all parts in warm water with a mild dish detergent for 15-20 minutes. Gently agitate the water.

  • Air Dry, Don’t Wipe: After soaking, rinse the parts briefly under clean water (some manufacturers recommend not rinsing to maintain anti-static properties, so always check your specific model’s instructions). Shake off excess water and allow all parts to air dry completely on a clean, lint-free surface. Do not wipe with a cloth or paper towel, as this can create static electricity that attracts medication particles to the walls of the spacer.

    • Actionable Tip: If your spacer’s instructions say not to rinse, just soak and air dry directly from the soapy water. The thin film of detergent helps reduce static.

    • Concrete Example: After soaking the AeroChamber, you would simply shake off excess water and place it on a clean dish rack or paper towel to air dry overnight.

3. Inspection for Damage

Regular checks prolong the life and effectiveness of the spacer.

  • Visual Check: Before each use, quickly inspect the spacer for cracks, chips, or any signs of wear. Check that the valve (if present) is intact and moves freely.
    • Actionable Tip: A damaged spacer can leak medication or fail to deliver the correct dose, so replace it immediately if any damage is found.

    • Concrete Example: If you notice a small crack near the mouthpiece, discard the spacer and replace it.

4. Timely Replacement

Spacers don’t last forever.

  • Annual Replacement (or as per manufacturer): Most manufacturers recommend replacing spacers every 6-12 months, even if they appear undamaged. Over time, plastics can degrade, and anti-static properties can diminish.
    • Actionable Tip: Mark the purchase date on the spacer itself or in your child’s medical notes to track when it needs replacement.

    • Concrete Example: If you bought the spacer in January, plan to replace it by the following January, even if it looks fine.

5. Individual Use Only

Spacers are personal medical devices.

  • Do Not Share: Never share a spacer between children, even if they have the same medication. This is for hygiene reasons and to prevent cross-contamination.
    • Actionable Tip: If you have multiple children requiring spacers, ensure each child has their own clearly labeled device.

    • Concrete Example: Label each child’s spacer with their name using a permanent marker.

Troubleshooting Common Issues

Even with the best preparation, challenges can arise.

1. Child Refusing the Spacer

Patience and positive reinforcement are crucial.

  • Distraction and Play: Make it a game, use a favorite toy as a demonstration, or distract with a book or screen during administration.
    • Actionable Tip: Allow the child to decorate the spacer with stickers (avoiding the mouthpiece/mask area) to personalize it.

    • Concrete Example: “Let’s give Teddy his medicine first!” or “Let’s watch your favorite cartoon while we do this.”

2. Poor Seal with the Mask

A common issue that reduces effectiveness.

  • Repositioning and Comfort: Try different angles or gentle pressure points to achieve a good seal. Ensure the child is calm and not crying, as this makes sealing difficult.
    • Actionable Tip: If the mask is too large or too small for your child’s face, it’s the wrong size and needs to be replaced with an appropriate one.

    • Concrete Example: If the mask is leaking air, gently adjust its position on their face. A good indicator of a seal is the valve movement (if present).

3. Whistling Sound (for some spacers)

Indicates too fast an inhalation.

  • Slow Down: If your spacer whistles when your child inhales, it means they are breathing in too quickly.
    • Actionable Tip: Instruct them to breathe slower and more steadily.

    • Concrete Example: “Slow down your breathing, like you’re sniffing a flower very gently.”

4. Medication Residue Inside

Normal, but excessive residue can indicate static or poor cleaning.

  • Check Cleaning Method: Ensure you are following the correct cleaning protocol, especially regarding air drying and avoiding wiping.
    • Actionable Tip: If residue persists despite proper cleaning, the spacer may be old, have lost its anti-static properties, or be damaged, requiring replacement.

    • Concrete Example: If the inside of your spacer looks consistently cloudy or coated shortly after cleaning, it might be time for a new one.

Finding the ideal child-friendly spacer is an active process, involving careful selection, diligent use, and consistent maintenance. By prioritizing age-appropriateness, valved holding chamber functionality, durability, and ease of cleaning, parents and caregivers can ensure their children receive the full therapeutic benefit from their inhaled medications. This detailed guide empowers you to make informed decisions and implement best practices, ultimately contributing to better respiratory health outcomes for your child.