A tracheostomy (track-ee-os-tohmee) is a small, surgical opening through the skin into the windpipe (trachea).

There are many reasons why children may need a tracheostomy. The most common is to relieve severe breathing difficulties due to an obstruction (blockage) or narrowing in the upper airway. Other reasons include a child needing to be connected to a machine (ventilator) that helps with their breathing, or they need to have frequent suctioning of mucus from their airway if they can't swallow their saliva properly.   

About the procedure

While your child is asleep under a general anaesthetic, a curved plastic tube (tracheostomy tube) will be inserted into their windpipe through a cut in their throat, and secured. Your child will breathe through this tube instead of their nose and mouth. The tube doesn't go into the lungs.

After the operation

Children normally recover from the operation quickly. Your child will need to stay in an intensive care unit to make sure the first tube can be safely changed (normally between five and seven days after surgery). Once the tube has been changed without any complications, your child will be transferred to a ward.

Eating and drinking

In most cases, a child with a tracheostomy can eat and drink without any trouble once they have recovered from the operation. A speech pathologist may assess your child's ability to swallow before your child is given any food or drink.

Speech and sound

The tracheostomy tube usually affects speech to some degree, and at first your child may not be able to produce any vocal sounds (speech or crying). The amount of sound your child will be able to make depends on several factors, including:

• how severe your child's airway obstruction is 
• whether the vocal cords are working properly 
• the size of the tracheostomy tube.
  

Your child may have a speaking valve attached to the end of their tracheostomy tube. This one-way valve directs exhaled (breathed-out) air through the trachea and upper airway, helping your child to speak.      

Even if they are not able to speak, spend time talking to your child. Allow them time to respond and be encouraging. By observing their facial expressions and behaviour, you will be able to recognise and understand their needs.

Speech pathologists are available if you need help. You may also consider learning some simple sign language with your child so that you can communicate together.

Care at home

Extra care and supervision is required for a child with a tracheostomy. A specialist team will help you learn the different procedures you will need to do when caring for your child after they leave hospital. This may include suctioning, planned replacement, emergency replacement and flushing. Although these things may seem scary at first, the more practice you have, the more confident you will feel. Once you feel comfortable doing all the care that your child needs, your child can go home.

Essential equipment

You will need to keep a supply of the following with your child at all times:

• tracheostomy tube of the same size and spare ties
• tracheostomy tube one size smaller
• portable suction pump and suction catheters
• scissors
• mucus trap (for emergency suction)
• sterile saline and syringe
• one-way valve for expired air resuscitation.

It is a good idea to keep these together in a container or bag, labelled with your child's name and contact details.

Care around water

Children with a tracheostomy tube must not immerse the tube under 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
• wash your child’s hair by tilting their head backwards.

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

Avoid using powders or aerosol sprays around the tracheostomy tube, as they may cause breathing problems.

Playtime

When your child goes home, they will be able to carry on with most of their normal activities. Your child should be encouraged to play, but you will need to watch them at all times. Don't have small toys or objects around a young child, as there is a risk of them breathing small items in through the tube.

Careful supervision is necessary when your child is around sand. If possible, avoid sand pits and beaches. Older children may have to avoid contact sports such as football and basketball.

When to see a doctor

Your treating team will arrange regular follow-up to ensure your child's tracheostomy is safe and functioning well. You will be given an individual action plan for tracheostomy management and emergency scenarios.

Follow-up

A tracheostomy may be permanent, long-term or short-term, depending on the needs of your child. Your child will have regular medical appointments, and the removal of the tracheostomy tube will be planned once the medical team is confident that your child can breathe well without it.

Your child will need to stay in hospital for at least one to two nights when the tube is removed. 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. Your child will be monitored closely by the nursing staff. If your child can breathe well with the tube blocked, it is taken out the next morning.

Key points to remember

• There are many reasons why a tracheostomy is needed. The most common reason is to relieve severe breathing difficulties.
• 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.
• Keep young children away from small toys and objects, and sand.
• A tracheostomy may be permanent, long-term or short-term. Removal will be planned once your child can breathe well without it.

For more information

• Call your Respiratory nurse or doctor.
• Emergency tracheostomy management and CPR for families
• Better Health Channel: Tracheostomy
• Aaron's Tracheostomy page
• More than my tracheostomy
  

• Global Tracheostomy Collaborative page

Developed by The Royal Children's Hospital Respiratory and Sleep Medicine department. We acknowledge the input of RCH consumers and carers.

Reviewed April 2018.

This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.