Kids Health Info

Tracheostomy - information for parents

  • How you say it: track-ee-os-tohmee

    A tracheostomy is a small, surgical opening (stoma) from the skin into the windpipe (trachea).

    A curved plastic tube (tracheostomy tube) is inserted into the windpipe (trachea) through the hole and the child breathes through this tube instead of their nose and mouth. This tube doesn't go into the lungs.

    Frequently asked questions

    Why is a tracheostomy necessary?

    There are many reasons why a tracheostomy is needed. The most common reason is to relieve severe breathing difficulties due to an obstruction or narrowing in the upper airway. Your child's doctor can explain why a tracheostomy is necessary for your child and for how long it may be needed.

    Other reasons for a tracheostomy may include:

    • your child needs to be connected to a machine (ventilator) which helps with their breathing
    • they may need to have frequent suctioning of mucous (secretions) from their airway if they can't swallow their saliva properly and this interferes with their breathing.   

    What happens after the tracheostomy is put in?

    Children normally recover from the operation quickly. Some children are active and feeding by the third day after the operation. When breathing becomes easier and your child's energy levels increase, they may also show improved weight gain.

    At the RCH, the child is usually nursed in the Intensive Care Unit (ICU) for at least four to seven days. This is to make sure the wound where the surgical cut was made has healed. Your child will need to stay in ICU to make sure the first tube can be safely changed (normally day 5-7). Once the tube is changed (without any complications), your child will be transferred to the ward.

    Will my child be able to speak?

    The tracheostomy tube usually affects speech to some degree and at first your child may not be able to produce any vocal sounds.The amount of sound (speech) made depends on how well air can be directed out past the tracheostomy tube and through the voice box (larynx) and  throat (upper airway).

    Several factors may influence your child's vocalisation/crying such as:

    • how severe the airway obstruction is 
    • whether the vocal cords are working properly 
    • the size of the tracheostomy tube that your child has in place 
    • how much air goes past the tracheostomy tube and up through the larynx (voice box) and upper airway.

    Even though your child may not make any vocal sounds at first, as the child grows, normally their airway grows too. If the tube remains the same size, their voice will usually improve. Sometimes children can use a special speaking device which helps to improve the flow of air up through the voice box (larynx) and throat.          

    You should treat your child as you would any other child. Spend time talking to them, read books together and allow them time to respond and offer them encouragement even if they can't vocalise.

    Speech pathologists are available if you need help. You may also consider learning sign language with your child if they are unable to speak, so that you can communicate together. There are community-based centres that can help with this.

    Will my child be able to eat/drink normally?

    In most cases a child with a tracheostomy can eat and drink without any trouble. They are able to start their usually oral intake (food or drink) once they have recovered from the operation. You need to be watchful that the food and fluid "doesn't go down the wrong way"

    Here are some suggestions to help you feed your child safely:

    • If necessary, suction your child before they begin eating meals. Try to avoid suctioning your child during feeds/mealtimes because this can cause vomiting.
    • During mealtimes it's important for your child to be supervised - if any food or fluid goes into the tracheostomy tube it should be suctioned immediately.
    • If bottle feeding an infant, don't 'prop up' the bottle or feed the baby while they are lying down.
    • Infants who are breastfed can continue to do this without any trouble.
    • Keeping the tracheostomy tube covered by using a filter (HME or tracheostomy bib) during mealtimes can help to prevent fluid/food going into the tube.

    While most children can eat and drink normally following the insertion of a tracheostomy tube, in some children it may affect their ability to swallow safely. It may also influence how the child feels about eating and drinking. Children who had problems with feeding before the tracheostomy tube was inserted may continue to have the same issues while for others, feeding may improve.  

    It may be necessary to arrange for a speech pathologist to assess your child's ability to swallow before giving them drinks or food.

    Will my child be able to go home with the tracheostomy tube?

    Yes. There is certainly extra care and supervision required for a child with a tracheostomy but as soon as you are ready there is a specialist team who will help you in learning how to care for your child.

    Although they may seem scary at first, these procedures are not painful for your child and the more practice you have carrying out the procedures on your child while your child in hospital, the more confident you will feel. Once you feel comfortable about doing all the care that your child needs, your child will be able to go home and carry on with their normal activities.

    How will I know when my child needs me?

    You will learn to recognise your child's individual responses and signals. By observing their facial expressions and behaviour you will be able to recognise and understand their needs.

    If your child is unable to vocalise, you may consider buying an intercom (baby monitor) or microphone to place close to them so that you can hear when they wake and require suction.

    Does my child need to wear special clothing?

    You don't need to buy special clothing for your child, as any type of clothing is fine as long as the clothing doesn't block the tracheostomy tube (e.g. polo necks or plastic or plastic-backed bibs), or have loose fibres/threads or beads which may get into the tracheostomy tube and affect your child's breathing.

    Can my child bathe and swim?

    Children with a tracheostomy tube must not  immerse their tracheostomy tube under the water because there is a risk of drowning.

    During a bath:

    • children need to be supervised at all times
    • the water level must be shallow
    • make sure water does not get into the tracheostomy tube
    • avoid using powders or aerosol sprays around the tracheostomy tube - as they may cause breathing problems
    • wear a HME (Heat Moisture Exchanger)
    • wash hair by tilting the head backwards

    Some older children are able to swim and shower safely. You will need to discuss this with your child's doctor.

    Playtime, beaches and sand pits

    Your child will enjoy play and this should be encouraged but you will need to watch them at all times while they are playing. Don't have small toys or objects around a young child to avoid the  risk of them breathing anything in through the tube.

    Careful supervision is necessary when they are around sand. If possible, avoid sand pits and beaches. The young child should be encouraged to wear a filter or cover the tracheostomy with a light scarf. Older children may have to avoid contact sports such as football and basketball.

    When is the tracheostomy tube taken out?

    Your child will have regular medical appointments. The removal of the tracheostomy tube is planned once the medical team is confident that your child can breathe well without it.

    Before planning to take out the tube, an assessment of the airway is done by a special test called a bronchoscopy. The bronchoscopy results, together with how well your child can talk and breathe with the tube in place, will help the doctor decide if your child still needs the tracheostomy tube.

    What happens when the tube is removed?

    Your child will need to stay in hospital for at least 1-2 nights when the tube is removed. There are different ways of removing the tracheostomy tube - depending on the reason the tracheostomy tube was put in.

    Usually a smaller size tracheostomy tube is put in and then this is blocked overnight to see how well your child can breathe through their nose and mouth, rather than through the tracheostomy tube. If they can breathe well with the tube blocked, it is taken out the next morning.

    What if my child can't breathe well without the tube?

    Your child will be monitored closely by the nursing staff. If they can't manage to breathe well without the tube, it may need to be put back in.

    What if my child needs respiratory support?

    Your child's ability to breathe well, even with the tracheostomy tube, may be affected by some medical conditions and they may need some breathing support. This could include conditions such as:

    • laryngomalacia
    • tracheomalacia
    • chronic lung disease (CLD)
    • hypoventilation syndrome
    • neurological disorders
    • a severe respiratory infection.

    This respiratory support may be either breathing (ventilation) support, oxygen therapy or both. If your child needs breathing (ventilation) support at home, all the necessary equipment will be provided by the hospital and you will be taught how to care for your child at home.

    Key points to remember

    • There are many reasons why a tracheostomy is needed.
    • The most common reason is to relieve severe breathing difficulties.
    • A tracheostomy may be permanent, long term or short term.
    • Your doctor will make sure you know why your child is having a tracheostomy.
    • You will be taught how to look after your child while they have the tracheostomy.
    • Children with a tracheostomy must keep the tracheostomy tube out of water.

    For more information

    • Emergency call an ambulance (Dial 000).
    • Royal Children's Hospital
      T: (03) 9345 5795 (direct line for Respiratory Nurse) or
      via the switch on (03) 9345 5522 - ask them to page the Respiratory Nurse or Respiratory doctor on call.
      The Respiratory Nurses are here to help you and your family and are available on weekdays to answer any questions or concerns you may have.
    • General information, email discussion groups and parental support are available at ONTRach support group
    • Aaron's Tracheostomy

     

    Developed by the RCH Department of Respiratory Medicine. First published in March 2008. Updated November 2010.

We want your feedback!  

Please complete this short survey (takes 2 minutes) to help us further improve this resource, thank you. 


Disclaimer 
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.