A tracheostomy (say “trayk-ee-AW-stuh-mee”) is a surgical procedure.

An incision (cut) is made in the neck and windpipe (trachea) to create a small hole called a stoma. Then a special breathing tube called a tracheostomy tube or trach (say “trayk”) is inserted into the windpipe. This helps your child breathe.

A child with a trach tube inserted, and how air moves in and out of the trach tube as a child breathes.
Credit: AboutKidsHealth.ca

Here you will find general information to help manage your child’s health after a tracheostomy, including:

• answers to common questions
• education you will receive in the hospital
• supports you will have at home
• how to recognize and manage tracheostomy emergencies

Why does my child need a tracheostomy?

A child may need a tracheostomy for one or more reasons:

Sometimes a child's airway is too small or blocked and not enough air can flow in and out of the lungs through the nose and mouth. A child may be born this way or have had an illness or accident.

Children with health conditions that affect breathing may need a ventilator to help them breathe.

A child may need help keeping their airway clear because of difficulties with swallowing or other challenges.

Will my child always need a trach?

How long your child has a trach depends on why they need it. Your child’s healthcare team will talk with you about your child’s expected journey, including if and when they can breathe safely without the trach.

While your child has a trach, your healthcare team will order tests and procedures to check if your child still needs it. This will depend on your child’s health.

If your child’s trach can be removed, the hole in the windpipe may heal on its own, or your child’s surgeon may need to close it. Once the trach tube is out, your child will breathe through their mouth and nose again.

How do I care for my child’s trach?

While your child is in the hospital, you will get training on how to take care of your child’s trach and their specific needs. Two family members (decided by the parents) are encouraged to do the training.

Learning to care for your child’s trach takes time. Training will happen at your own pace as you become more confident. Sometimes you will use a mannequin to help you learn and practise the skills, such as:

• cleaning the stoma
• using a suction machine to remove mucus from the trach
• changing the trach and the ties that hold it in place
• recognizing and managing trach emergencies

It will take time to feel confident with your new skills. Your healthcare team will make sure you feel comfortable and have safe tracheostomy-care skills before your child leaves the hospital.

Your child will have their own specific care plan. Your Home Care team will work with you to develop this plan.

You may be involved in teaching trach-care skills to other caregivers, family members, and school aid workers who will be part of your child’s care in the community.

What if there is a problem with my child's trach?

At the hospital, you will learn all about tracheostomy emergencies. This includes how to recognize problems and emergencies, emergency procedures, and what you need in your trach emergency kit.

When can my child go home with a trach?

It may take months or longer for your child to go home with a trach, depending on their medical needs. Your child can go home with a trach when:

• They are medically stable.
• You have all the skills you need to care for them safely at home.
• The medical equipment your child needs at home is ready.
• If needed, home caregivers have been hired and trained to help care for your child overnight in your home.

How will my child be supported when we go home?

A Home Care team will help you make sure your home is ready and safe for your child. They will:

• Make sure you can get your child in and out of the home safely.
• Help you set up a room for your child so their care needs can be met.
• Share tips on how to organize medical equipment and supplies.

You will also have a respiratory vendor to help with equipment and supplies.

Caregivers may be hired to help care for your child at home, depending on your child’s medical needs and where you live. You may qualify for home caregivers through a third-party agency, or you may need to hire your own caregivers. The Home Care team will work with you to find the solution for your family before your child goes home.

How can I protect my child’s health?

A child with a trach has a higher risk of infections and other health problems. To help prevent the spread of infections:

• Make sure your child and family members are up to date on their immunizations.
• Have everyone in your home wash their hands well and often.
• As much as possible, limit your child’s contact with people who are sick.

To protect your child’s airway and lungs:

• Use a standard home air purifier and filter in your home.
• Use the special humidifier provided by your respiratory vendor. (Regular home humidifiers do not provide enough humidity for your child.)
• Never let anyone smoke around your child. If needed, there are many resources to help you or your family members quit smoking.
  
• Keep small items and toys with small pieces or fur that sheds away from your child. This includes art supplies like glitter and sparkles. They could get into the trach tube and into your child’s lungs.
• Be cautious when choosing playgrounds and parks for playtime. Sand could get into your child’s trach tube, causing a blockage or infection.
• Avoid swimming and water activities. Water can get into the trach tube and into your child’s lungs.

If you want support for how to protect your child’s airway in your home or around other people, talk to your child’s healthcare team.

What kinds of activities can my child do with a trach?

Your child is encouraged to do any activities they enjoy and are able to do. It depends on their health and why they have a trach. Talk to your child’s healthcare team about what activities are safe for your child.

Playing, including playing with toys, is good for your child and is important for their development. Always watch over your child while they play, and make sure small toys or objects that could get into the trach tube are not within reach.

For any outings, always bring your child’s emergency kit and emergency trach supplies. It is highly recommended to always have a trained trach caregiver or family member ready to care for your child. For example, if you are driving, have a trained adult sit next to your child in the back seat.

Some activities are challenging when your child has a trach. For example, swimming is not recommended, because water can leak into the stoma and into your child’s lungs.

If you aren’t sure if an activity is safe for your child, speak with your child’s healthcare team. Sometimes they can help you adapt an activity so your child can do it safely.

Can my child bathe or shower with a trach?

If your child is young, bathe them with 2.5 to 5 cm (1 to 2 inches) of water in the tub. If your child is not on a ventilator, you may need to cover the trach with a special cap called a heat moisture exchanger (HME). Always stay with your child while they are in the tub.

If your child is older, they may shower. Make sure they know how to guard their trach from water. Have your child ask help if they need it.

Can my child talk with a trach?

If your child could talk or make sounds before their tracheostomy, they likely won’t be able to when they first get a trach.

Over time, some children learn to breathe out in a way that allows them to make sounds and talk. Others may use a speaking valve to help them make sounds.

A speech therapist and other members of the healthcare team will work with you and your child to help your child communicate.

Will my child need a ventilator at home?

Some, but not all, children need to go home with a ventilator (breathing machine) to help them breathe. Some children only need a ventilator at night. Others need a ventilator 24 hours a day.

Your healthcare team will talk with you about how much ventilator support your child may need.
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