An 11-year-old child with cerebral palsy required hospital admission for respiratory distress following administration of high-frequency chest wall compression (HFCWC). The child had severe neurologic impairment and an ineffective cough effort. HFCWC is effective in treating cystic fibrosis, but its use has not been widely studied in other diagnoses. Although highly effective in mobilizing mucus, HFCWC does not assist in removing airway secretions. In the absence of an effective cough, additional devices or techniques may be required.