We tried lots of things to make DD feel comfortable with the puffer and spacer.

We let her play with it, so that it no longer became something scary, we let her put her face to the mask, when she was ready, and we also tried doing some puffs during her sleep.

Another one was putting it to yours or DH's faces (having to clean inbetween), showing it was ok.

Counting out aloud for each breath (they need to take in 6 breaths for all of the ventolin to be absorbed) and saying 3 more, 2 more etc as each dose was done. Congratulations for each one. And if a break is needed we give it.

It can be very distressing for them and sometimes if they are upset it can be better as they take in a deeper breath when they are crying

HTH's, it may be distressing but in time it does get easier :hug;