Tracheostomy 101

A tracheostomy (trake-ee-AWS-toe-mee) is a type of surgery where a small hole is created in the windpipe (trachea) through an incision (cut) in the neck. The hole created is called a stoma. A special tube (trach tube) is then placed in the hole to help children breathe.

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Why does my child need a trach?

Your child may need a trach for many different reasons. Some common reasons are:

• To allow use of a breathing machine (mechanical ventilator) to help your child breathe. Children who have severe lung problems, or other health problems that affect breathing, may need to use a ventilator to help them breathe
• To help keep your child's airway open. Sometimes a child's windpipe is too small or blocked to allow enough air to flow in and out of the lungs. This can make it very hard for the child to breathe. The trach can help keep the child's airway open.

How long will my child need a trach?

How long a trach is left in depends on why the trach was needed. When it’s time for the trach to come out, your health care team will discuss this with you. Before removing it, your child's doctor may do a procedure to check your child's airway. Once the trach tube is out, your child will breathe through his or her mouth and nose again. The trach opening usually heals on its own. In some cases, surgery may be required to close it.

Taking care of your child's trach

Taking care of your child's trach requires certain basic skills that you will learn while your child is in hospital. Hospital staff will provide education sessions and support you while you practice on a simulation mannequin with a trach to ensure that you are confident in your ability to care for your child’s trach. This can take several weeks. A child with a trach can go home when they are medically stable and you as a family feels prepared to safely care for their child at home. A home care team will help get you ready to go home. You will have a respiratory vendor to help you with the equipment and supplies that you will need at home and you will have trained caregivers that will help you care for your child in your home.

How often does a trach need to be changed?

A trach needs to be changed regularly. Mucus and bacteria can build up over time inside the trach. Your healthcare provider can help you decide how often the trach will need to be changed. You should always have a replacement tube nearby as well as a back-up trach tube one size smaller.

Can my child talk with a trach?

Children are unable to talk when they first get their trach. This can be frustrating for families and children who were able to talk before getting a trach. A speech therapist or other members of your child's healthcare team will work with you and your child to learn new ways to communicate. Some children are able to use a speaking valve that is attached to the trach to help them speak more clearly and loudly (Passey-Muir® valve). Children with weaker muscles may not be able to use a speaking valve.

What problems can happen with my child's trach?

You will receive education about trach problems and emergencies.

Serious problems that can happen with your child's trach are:

• The trach tube becomes obstructed (blocked). If your child appears to have breathing problems, such as fast breathing, working hard to breathe or turning blue, the trach tube may be blocked.
• The trach tube accidentally comes out and becomes dislodged.

If any of these problems occur, follow the emergency procedures that you have been taught and then call Emergency Medical Services (9-1-1) immediately.

Other problems that are not as urgent as those listed above, but need to be reported to your child's healthcare provider are:

• Your child is having a harder time breathing. (The trach tube may be partly blocked.)
• You see a small amount of bleeding in or around your child's trach.
• You think your child has an infection. Signs of an infection can be: changes in the amount, color, odor, or thickness of the mucus in or around your child's trach; your child is having more difficulty breathing than usual; fever.

Things to remember about a trach

If your child has a trach, there is a higher risk of respiratory infection and other complications. Tips to help your child stay healthy with a trach include:

• Avoid infections by:
  • washing hands often and thoroughly
  • making sure your child and family members receive immunizations, including flu immunizations
  • keeping your child away from others who are sick
  • avoiding crowded places like daycare centers and malls
• Carry trach emergency supplies with your child at all times. All parents and caregivers should know how to perform CPR (cardiopulmonary resuscitation) on a child with a trach.
• You should always have telephone service available. A land-line or cellular phone is needed at home and a cellular phone is helpful during travel.
• Avoid anything that risks exposure of irritants to the lungs, like dust or smoke.
• Keep small toys or objects that could be put into the trach away from your child.
• Since contact sports and water sports are not usually allowed, ask your healthcare provider what sports your child can play once home.
• At home when bathing, try not to get water in the trach. Young children may be bathed in 1-2 inches of water with the caregiver close at hand. Older children may shower if they have been taught how to guard their trach from water.
• Your child may be able to continue with normal activities depending on their diagnosis and why their trach was placed. Talk to your health care team if you have questions.

Additional Resource:

Trachea - About Kids Health

Find more information, including pictures and diagrams on this page.

This material is designed for information purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please contact your doctor or appropriate health care professional.

Reviewed December 2016