Tracheostomy Care in children
A distinctly serious topic.But a necessary one.
I realized this when working as a resident in Safdarjung Hospital New Delhi, many caregivers would often ask persistent questions regarding home care.
All children may not be fit for home care.
But for those who are otherwise alright, home environment often speeds up their recovery to a tube free life.
What is tracheostomy?
Tracheostomy is an opening made in the anterior wall of the breathing tube or trachea.
For children the opening is generally a slit in the tracheal cartilage and the cartilage itself is never removed.
It’s a life-saving procedure.
What are the indications of tracheostomy in children?
Indication for Pediatric tracheostomy
- To relieve upper airway obstruction(most common)
- To prevent complication of prolonged ventilation
- To reduce anatomical dead space
- Allow suction toilet of trachea
Indication of upper airway obstruction potentially requiring tracheostomy
Nose, Nasopharynx, oropharynx, base of tongue:
- Choanel atresia
- Macroglossia
- Treacher Collins/Goldenhar Syndrome
- Cystic hygroma
Supraglottis and glottis:
- Supraglottic cyst
- Vocal cord palsy
- Physical trauma
Subglottis trachea:
- Tracheomalacia
- High tracheal stenosis
Conditions which may require prolonged ventilation
- Failure of control over breathing
- Chest wall dysfunction
- Disorders of Lung parenchyma
- Large Airway disease
- Central sleep apnea (Ondine’s curse)
- Thoracic dystrophy
- Bronchopulmonary dysplasia
- Tracheobronchomalacia.
The serious nature of the conditions which require tracheostomy will give you an idea, about why this procedure helps to save lives. is only done when all other conservative options fail.
Itis only done when all other conservative options fail.
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So what should parents and caregivers of children living with tracheostomy know?
1)Acceptance
I know it’s difficult to watch a child breathing through a tube.
You wonder why innocent children have to suffer.
But that tube will help the child live healthier.
Always remember when condition improves , tracheostomy is a totally reversible procedure , with little morbidity.
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Acceptance of a tracheostomized child is important. As your child breathes and feeds better , your unconditional love and support will help him/her accept the tube and live healthier.
As your child breathes and feeds better , your unconditional love and support will help him/her accept the tube and live healthier.
2)Suctioning the tracheostomy Tube
The suction catheter should not be passed more than 1cm beyond tube tip to avoid tracheal damage.
With time , secretions become less.
Then you need to suction less frequently.
Humidification of inspired air by using nebulizer & tracheostomy mask helps to prevent excessive drying and irritation of trachea.
The suction should be made to suck some clean water after every tracheostomy Tube suction and kept clean.
The suction tube should be changed regularly.
The frequency of change ideally should be every 2 to 3 days , but will depend on the condition of child.
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3)Supervision and sleeping
Baby with a new tracheostomy should be sleeping near parent.
This helps in becoming familiar with the sounds she makes and to determine the frequency of suctioning.
It’s good to keep a child monitor next to the child at all times.
4)Change of tube
First change of tube is always done by a doctor.
Then after you can learn to change tube under supervision by a trained healthcare worker.
This makes you confident and keeps you aware about potential hazards.
- When you come home the tube may be changed weekly if no cheat infection present.
- If the child has Chest infection then it’s better you change tube, every 2-3 days
- Never change tube at home alone.Always 2 caregivers should be present during the change of tracheostomy Tube.
- In hot humid climate, it’s better to change the Tracheostomy Tube tape daily.One side at a time should be changed by 1 caregiver while the other caregiver holds the tube in place
- Always wash your hand with soap and water before touching the tube.
- Before insertion of fresh tracheostomy tube, lubrication with xylocaine jelly helps to lessen the irritation.
5)Bathing
Swimming is not allowed.
The bath should always be supervised even for older children.
Better not to use an overhead shower.
A handheld shower or bucket -mug technique works best.
6)School
If the child has no other problem, regular schooling should be continued.
But it’s important for the teachers, healthcare workers, and school authorities to be aware of the condition, potential hazard, and emergency management procedure.
7)Discipline
When we are ill we are pampered.
But as the child gets better it’s best to treat him /her as you would any other child.
Discipline and all other activities should be like a normal child.
You should encourage him /her to participate in activities as far as possible (discuss with your doctor if your child’s special condition has any restrictions ).
Dress the tracheostomy Tube with a nice scarf to avoid unpleasant curiosity and help your child feel like the other little ones.
8)Speech and Language development
An assessment by a speech therapist early helps you plan better.
- Tracheostomy tube with a speaking valve is a must.
- Encourage both verbal and nonverbal means of communication with your child.
9)Travel
Wherever child goes, a suction pump must go.
- Suction pump
- Spare tracheostomy Tube
- Tape
- Xylocaine jelly
- Suction catheter
- Syringe
- Saline
- Scissors
10)Equipment needed for Home care of Tracheostomy tube
- Tracheostomy Tube
- Suction catheter
- Suction pump 3
a)Permanent at home
b)portable suction pump for travel
c)Manual: in case of power disruption, malfunction, regular cleaning and service of pump
11)Skin Care:
- Keep the tape clean and dry at all times
- Every day put a clean soft piece of gauze tucked between the skin of the neck and the side flanges of the tube.
- This gauze should be changed as soon as it gets wet
- Clean the skin around the tracheostomy opening with a gauze soaked (and rinsed dry) in mild antiseptic solution, keeping in mind to make the skin dry afterward.
12 )Requirement for children at home with tracheostomy
- Caregiver : At least 2 responsible adults
- The environment at home: Adequate space, heating, cooling, humidifying facility.Having a telephone and access to transportation.
- Healthcare Support system:
District Nurse
Community pediatrician
General Physician
Hospital nearby
Community support
Having a child with a tracheostomy is a big challenge.
But if your child is otherwise healthy and you are willing to learn .
You can take care of a tracheostomy at home.
But every case is unique and the best guide to your child’s conditions is your doctor.
Stay informed and stay healthy.
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Disclaimer :
The information provided here is strictly for the purpose of helping you live better and not to be confused with professional medical advice which is only given after professional consultation.
Image courtesy Aniruddha Das
