A tracheostomy tube is inserted into the windpipe (trachea) through a surgically created opening or hold in the neck called a stoma. The operation to make the stoma is called a tracheotomy.
The tracheostomy tube is inserted through the stoma to allow for the passage of air and removal of secretions, such as mucous. Your child will now breathe in and out through the tracheostomy tube instead of through their nose and mouth.
Why do infants and children need tracheostomy tubes?
Children may need a tracheostomy tube for a number of reasons, including:
- To provide a child with breathing support.
A tracheostomy tube may be required when a child needs to have a ventilator to assist their breathing over a long period of time. Your child might have a condition where their nerves or muscles involved in breathing do not work properly, or they fatigue easily, such as congenital myopathy, bronchopulmonary dysplasia and spinal injuries.
- To provide a clear airway when a child has an obstruction/structural anomaly.
A child is sometimes born with structural problems in their airway, head or neck, which can make it difficult for them to breathe. Examples of this include subglottic stenosis (narrowing of the airway), laryngeal webs, tumours or growths, paralysed vocal cords, or laryngomalacia (a floppy voice box). A child may also have a condition that affects the shape of parts of their head and neck, such as a tumour, Pierre Robin sequence or Goldenhar syndrome, which means they may require a tracheostomy tube.
- To assist clearing the airway of secretions.
Children can have medical conditions where they are unable to swallow their saliva or they may produce excess secretions that are difficult to clear from the chest. This may lead to frequent respiratory infections and poor health. A tracheostomy tube enables their parent/carer to suction the secretions and keep the child’s airway clear to allow the child to breathe more easily and maintain good respiratory health.
What does a tracheostomy tube look like?
Cannula: This is the tube which sits inside your child’s trachea.
Connector/hub: This sits out from your child’s neck – this where you insert the suction catheter to remove secretions.
Neck plate/flange (wings): The flange sits against the neck and is secured by a Velcro device through the holes on each end.
Some tubes also have a balloon around the cannula inside the airway, called a cuff, which stops saliva and secretions from going in. A cuffed tube is generally only for older children.
How does having a tracheostomy tube affect my child?
Having a tracheostomy tube may affect your child in both positive and challenging ways.
Positive effects may include:
- Your child will be able to breathe more easily.
- Your child’s airways can now be cleared by removing secretions with suctioning.
- Your child’s health, growth and development may improve. Because they will now not use so much energy to breathe, your child may be more physically well. This will allow your child to grow, attain developmental milestones and learn new skills.
Challenging short or long-term side effects may include:
- Difficulties eating and drinking – while many children can eat and drink successfully and safely with a tracheostomy tube, some children experience feeding difficulties. Oral hypersensitivity, gagging and coughing with meals, food refusal and food or fluid going into the airway are some difficulties they may face. The speech pathologist will be able to work with you and your child to address these issues.
- Difficulties speaking and voicing – the tracheostomy tube allows your child to breathe easily in and out of the tube, but it may be difficult for air to move past the vocal cords (where voice is made) and into the mouth (where voice becomes speech). Some children will need to use gestures or signs to communicate, picture boards or other forms of communication. Another option is a “speaking valve” if tolerated – this will be assessed by your speech pathologist and medical team.
- Not being able to swim – your child’s tracheostomy tube means they will not be able to close off their airway safely for swimming.
Will my child ever have the tracheostomy tube removed?
Most children get their tracheostomy tube out when they are medically ready and their airway problems have resolved. This process is called “decannulation” and will require a hospital admission. Your medical team will continually monitor your child’s health and plan for this event.
Who should I contact to discuss my child’s eating, drinking or communication development?
You can contact your local speech pathologist to discuss where to access services for your child. They will assess your child’s communication and feeding development and recommend the interventions for your child at their stage of development.
For more information
See these other fact sheets in our Tracheostomy tubes series:
Tracheostomy tubes: Feeding, eating and drinking
Tracheostomy tubes: Using a speaking valve
Tracheostomy tubes: Communication options
Speech Pathology Department
Queensland Children’s Hospital
t: 07 3068 2375
ENT Clinical Nurse Consultant / Clinical Nurse
Queensland Children’s Hospital
t: 07 3068 1379