When Your Child Needs a Tracheostomy

Your child's healthcare provider has told you that your child needs a tracheostomy. This creates a new pathway for air. Surgery is needed to do this. During the surgery, the surgeon makes a small opening in your child’s neck. A tube (called a trach tube) is placed in this opening. Air then flows into and out of the trach tube, allowing your child to breathe. This sheet will help you learn more about tracheostomy.

Reasons for a tracheostomy

A tracheostomy may be temporary (used for a short time) or permanent. Here are some possible reasons for a tracheostomy:

• Need for long-term use of a ventilator (a machine that helps with breathing)

• Obstruction in the airway due to an accident, paralysis, surgery, or malformation

• The need for frequent suctioning of secretions in the airway

• Obstruction of the airway during sleep (sleep apnea)

How your child’s tracheostomy works

The surgery is done in an operating room or intensive care unit (ICU). Your child will be given medicine to make him or her sleep during the procedure. The surgeon creates a small opening in the neck, called a stoma. The trach tube is put into the stoma. One end of the trach tube rests outside the stoma. The other end rests inside the windpipe (trachea). When your child breathes in, air goes through the tube into the trachea to the lungs. When your child breathes out, air comes out of the trach tube. Your child can still also breathe in and out through his or her nose.

Helping your child adjust to a tracheostomy

Depending on your child’s age, it may take some time to adjust to a tracheostomy. You can help by becoming skilled in trach tube care. Also, stay as relaxed as possible. It will help your child to remain calm if problems occur. For example, if your child feels like gagging, help him or her relax. Have your child breathe in slowly and deeply. Here are some other ways to help your child:

• Eating. Follow any instructions you’re given about eating and drinking. Once your child is able to eat, encourage him or her to eat slowly and chew thoroughly.

• Talking. Your child may need speech therapy to learn how to make talking easier. Some children benefit from a speaking valve, which allows speaking with greater volume. It takes some time to adjust to the valve. If your child can’t talk, help him or her learn new ways to communicate—with flash cards, a small whiteboard, or facial expressions.

• Bathing. Make sure your child keeps the trach tube dry when bathing. You must watch your child while bathing, and don’t allow showering. To wash the hair, hold his or her head back, carefully supporting the head and neck. Keep water away from the trach tube.

• Being outside. In dirty or dusty areas, cover the trach tube with an artificial nose, also called a humidity exchanger. It contains a small filter. Avoid sandboxes and beaches. Stay inside on very cold or windy days.

• Playing. Supervise play with other children to prevent items being put into the trach tube or the trach tube getting pulled on. Do not allow contact sports or water activities.

Signs of a blocked or dislodged trach tube

These are signs that a trach tube is blocked or dislodged:

• Difficulty breathing, rapid breathing, or no breathing at all

• Gasping, grunting, wheezing, or whistling sound when breathing

• Restlessness

• Flared nostrils

• Sweaty, clammy skin

• Anxious or frightened look

• Pale or blue color around lips, mouth, or fingernails

• Skin between the ribs, in the hollow of the neck, or under the breastbone pulls in with each breath

If the trach tube is blocked or dislodged

Ask your child's healthcare provider whether you need to keep a resuscitation bag around. Keep a smaller-sized trach tube on hand as a backup. If there are signs of a blockage, first suction out the trach tube. If the tube is still blocked, change the trach tube and suction again. If your child continues to have trouble breathing or loses consciousness, call 911 or emergency services right away.