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Pediatric Pulmonology, Allergy, and Sleep Medicine

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Tracheostomy Management
For Appointments or to contact us, call 914-493-7585

Many children unfortunately require a tracheostomy, which is a small opening through the skin into the trachea, also known as the windpipe.  A small plastic tube, called a tracheostomy tube is placed through this small opening to help your child to breathe.

How does a tracheostomy tube work?

A tracheostomy tube or “trach” is designed to permit children to breathe while bypassing the normal nose, mouth and throat.  This can be lifesaving, though no one wants a child to have a tracheostomy tube if they don’t need it.  However, many times this is essential to help a child to bring in enough oxygen and exhale enough carbon dioxide.

Why might a child require a tracheostomy?

There are many reasons why a child might require a tracheostomy.  The most common reason is if the upper airways (nose, mouth and throat) are blocked somewhere along the way.  In that case, bypassing the obstruction is critical.  Sometimes it is because children are not able to expectorate their normal secretions by themselves, especially if they are weak because of an underlying neurological or muscular condition.  The tracheostomy allows parents and other caregivers to suction secretions directly.  Sometimes children need equipment at home, such as a mechanical ventilator to assist their breathing.  A tracheostomy is a common way to connect a child up to a mechanical ventilator. 

What are the risks of a tracheostomy?

While the surgery itself to insert a tracheostomy tube is fairly routine, this is not always the case, especially in infants and young children.  Our group works closely with the Pediatric Otolaryngologists at the Maria Fareri Children’s Hospital who are experts in performing this procedure in even the tiniest babies.

After a tracheostomy is placed, a child often has to stay in the hospital for at least week to be certain that the tiny hole required does not immediately close up again.

While tracheostomies are usually not major problems, some children are prone to recurrent infections of the trachea, which is called tracheitis.   This problem is one of the major reasons why we recommend that all children with a tracheostomy are followed by a pediatric pulmonologist trained and experienced in managing and preventing recurrent infections of the trachea.

Will my child be able to speak with a tracheostomy?

Many children, but not all, can speak with a tracheostomy.  For vocalization, a child must exhale air up from the lungs and through the voice box or vocal cords.  This is not always possible with a tracheostomy.  Fortunately, many children can speak with the help of a “Passy-Muir valve” which is attached to a tracheostomy tube. 

How do parents learn to care for a tracheostomy?

All children’s hospitals, including ours, have experience discharging children to their home with tracheostomies, and it is important that parents are properly trained before hand.  Our pediatric pulmonologists work closely with our pediatric otolaryngologists (ENT specialists) to assure that all training is completed. 

Can children with tracheostomies participate in normal activities?

The answer to this question varies from patient to patient and you should discuss this with your child’s pediatric pulmonologist.  When a child has a tracheostomy, air bypasses the nose and mouth and flows directly into your child’s lungs without the filtering of particles in the upper airway.  Therefore it is important to try as much as possible to keep the air your child breathes as clean as possible:

Try to keep your child away from cigarette smoke.  This is extremely important.  It is also advisable to minimize exposure to any chemicals such as cleaning products that produce strong odors. 

  • Your child should try to avoid breathing in heavy dust, sand from sand boxes or other powders or chemicals in large quantities.
  • Most physicians recommend that children with tracheostomies avoid contact sports.
  • In general, we discourage children with tracheostomies from swimming, since aspiration of water whether in a swimming pool or even in a bathtub can be very dangerous.  However, under careful observation, sometimes this can be possible.  But planning is essential for this to be done safely and swimming should never be done unless your child’s physician’s are in agreement.
  • Be wary of clothing or jewelry that may inadvertently cover your child’s tracheostomy.