In this section
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.
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
Other reasons for a
tracheostomy may include:
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
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.
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:
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
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.
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:
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
It may be necessary to arrange for a speech
pathologist to assess your child's ability to swallow before
giving them drinks or food.
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
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.
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.
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.
Children with a
tracheostomy tube must not immerse their
tracheostomy tube under the water because there is a risk of
Some older children are
able to swim and shower safely. You will need to discuss this with
your child's doctor.
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
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
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
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
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
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:
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.
Developed by the RCH Department of
Respiratory Medicine. First published in March 2008. Updated