Tracheotomy—Child

(Tracheostomy)

Definition

A tracheotomy is a surgical opening through the neck into the throat. The opening is called a stoma or tracheostomy. It may be temporary or permanent.

A tube called a tracheotomy tube will be inserted into the tracheotomy. Air may pass directly through this tube or tubing will be attached to a machine that assists in breathing.

Airflow Through a Tracheostomy

tracheostomy_tube.jpg
Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure    TOP

A tracheotomy is done to open a new pathway for air to move into the lungs. It may be needed because breathing is impaired by damage or illness in the upper airways such as:

  • Smoke or chemical inhalation, or burns
  • Infection
  • Nerve or muscle problems that affect the airway, such as vocal cord paralysis
  • Narrowing of the airway just below the voice box
  • Physical defects of the head, neck, or airway
  • Foreign body obstruction
  • Trauma
  • Tumors

A tracheotomy may also be done if long-term mechanical ventilation is needed. A tracheotomy allows for greater movement, the ability to eat and drink by mouth, and the ability to speak while receiving ventilation. It can also prevent aspiration of food and liquids into the lungs.

Possible Complications     TOP

Problems from the procedure are rare, but all procedures have some risk. Your child’s doctor will review potential problems, like:

  • Bleeding
  • Infection
  • Air trapped in the chest, lungs, or skin around the tracheostomy tube
  • Damage to nearby structures, such as vocal cords or esophagus
  • Lung injury
  • Nerve injury
  • Problems with swallowing, speaking, or eating
  • Blockage of the tracheostomy tube
  • Abnormal connection to esophagus or other structures—fistula

What to Expect    TOP

Prior to Procedure

Your child’s doctor will do the following before the tracheotomy:

  • Physical exam
  • Blood and urine tests
  • Imaging tests to evaluate the airway and surrounding structures

Talk to your child’s doctor about all medications your child uses. Your child may need to stop taking some medications prior to the procedure.

Anesthesia

General anesthesia will be used. Your child will be asleep during the procedure.

Description of the Procedure     TOP

A cut will be made in the skin of the neck. A section at the front of the windpipe will be removed. A tracheostomy tube will then be fitted into this opening in the windpipe. Depending on the situation, an inflatable cuff may be part of the tube. The cuff is most important when the tube is being used for mechanical ventilation, to keep air going into the lungs and not leaking into the mouth .The skin will be closed with stitches or clips.

How Long Will It Take?     TOP

15-30 minutes

How Much Will It Hurt?     TOP

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay     TOP

The length of stay will depend on the reason for the procedure. Most stays are 1-5 days.

Post-procedure Care     TOP

At the Hospital

Right after the procedure, your child will be in a recovery room where their blood pressure, pulse, and breathing will be monitored. Recovery may also include pain or anti-nausea medications.

The tracheostomy tube will be used for breathing as long as it is in place. The hospital staff will make sure the tracheostomy tube is working properly. In some cases, a chest x-ray can be used to evaluate the tracheostomy tube.

During your child’s stay, the hospital staff will take steps to reduce their chance of infection, such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your child’s incisions covered

There are also steps you can take to reduce your child’s chances of infection such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your child’s healthcare providers to wear gloves or masks
  • Not allowing others to touch your child’s incisions

At Home

Tracheostomy tubes need to be cared for on a regular basis. The hospital staff will teach you how to care for your child’s tracheostomy tube. It is important follow the staff’s instructions to prevent infection and airway obstruction. Other specialists will help your child adjust to the tracheotomy and learn how to speak and eat with the tracheostomy.

Tracheostomy tube care considerations include:

  • Regular cleaning and replacement of tube
  • Regular clearing of secretions
  • Keeping the airway open
  • How to use oxygen or a humidifier (if needed)
  • Learning to keep your child away from irritants that affect the airway such as
    • Strong odors
    • Powders and heavy dust
    • Sand
    • Fuzzy blankets, toys, or clothing
  • Speaking and eating techniques
  • Learning cardiopulmonary resuscitation (CPR)
  • Knowing when to call for emergency medical services

Call Your Doctor     TOP

After you leave the hospital, contact your child’s doctor if any of the following occur:

  • Signs of infection, including cough, excessive foul-smelling mucous, fever, or chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Pain that cannot be controlled with medications your child was given
  • Shortness of breath
  • New or worsening symptoms

Call for emergency medical services right away if:

  • Your child’s tracheostomy tube falls out and you can’t replace it
  • Your child is having problems breathing through the tube

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

American Pediatric Surgical Association
http://www.pediatricsurgerymd.org
The Society of Thoracic Surgeons
http://www.sts.org/patients

CANADIAN RESOURCES:

Caring for Kids—Canadian Paediatric Society
http://www.caringforkids.cps.ca
The College of Family Physicians of Canada
http://www.cfpc.ca

References:

About the procedure. Johns Hopkins Medicine website. Available at:
...(Click grey area to select URL)
Accessed November 12, 2015.
Care of the child with a tracheostomy. Cincinnati Children’s Hospital Medical Center website. Available at:
...(Click grey area to select URL)
Updated November 2009. Accessed November 12, 2015.
Deutsch ES. Tracheostomy: Pediatric considerations. Respir Care. 2010;55(8):1082-1090.
Frequently asked questions about tracheotomy and swallowing. American Speech-Language-Hearing Association website. Available at:
...(Click grey area to select URL)
Accessed November 12, 2015.
Things to avoid when your child has a trach. St. Jude Children’s Research Hospital website. Available at:
...(Click grey area to select URL)
Accessed November 12, 2015.
Tracheostomy care. St. Jude Children’s Research Hospital website. Available at:
...(Click grey area to select URL)
Accessed November 12, 2015.
Last reviewed November 2015 by Michael Woods, MD

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