Tracheostomy Care for Children

December 11, 2019
Janelle Thomas MSN, RN
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Taking care of a child is often an overwhelming, thankless, and trying experience. Yet, it’s still done every single day by parents and caregivers who couldn’t imagine life without their little ones. And when the child requires long-term medical care, everything becomes even more complicated.

If your child’s pediatrician has recently ordered a tracheostomy surgery, you may be feeling at a loss – wondering what it all means and what can you do to best care for your child. This is especially true since the procedure is necessary for children who need assistance to breathe. It’s scary stuff. However, it’s also manageable.

What to Expect During a Tracheostomy

Surgery will be required to create an opening in your child’s neck and into their windpipe. This is done to facilitate their breathing. Your child will first undergo general anesthesia. The surgeon will then make a small incision in the middle of the neck to expose the trachea. Once the aperture has been created, the surgeon will insert a tracheostomy tube into it, and secure it. After surgery, the surgeon and a nurse will meet with you and your family to provide instructions for proper tracheostomy at-home care.

The good news is that most children who undergo this procedure do not need to wear the tracheostomy permanently. The duration of therapy will depend on the individual child and their specific health conditions. However, it could be as little as several months or as much as a couple of years. After the tracheostomy is removed, the hole often closes by itself as it heals. In rare instances, a surgeon may have to operate to fully close it.

Guidelines for Caring for a Child with a Tracheostomy

There are several things you and caregivers can do to ensure proper care of your child’s tracheostomy. It’s crucial to pay close attention to the pediatrician’s care instructions since the frequency of tube changes varies greatly from child to child.

1. Learn how to suction the tracheostomy

This is done to remove mucus from the tube. This allows your child to breathe easier. When to do this depends on the child. The pediatrician will give you instructions. However, you can also learn to recognize your child’s breathing patterns and listen for anything unusual. If you hear rattling in the throat, see bubbles coming from the opening, see flared nostrils, your child’s nostrils are flared, you can hear a whistling sound, or your child is breathing faster than usual, it’s time to suction the tube. To do so, wash your hands thoroughly. Connect the suction catheter to the suction machine. Turn on the suction machine and set it to the pressure instructed by the pediatrician. Position your child on their back. Gently place the suction catheter into the tracheostomy tube – this only takes a few seconds. Always follow the pediatrician’s instructions. When you’re done, rinse the suction catheter.

2. Change the trach ties

The tracheostomy is held in place with trach ties. Changing them regularly prevents skin irritation as well as ensures that the trach is tied in place properly throughout the day. To change them, you’ll need someone to help you by holding the tube in place while you change the ties. Before beginning, wash your hands thoroughly. Place the child in a comfortable position and have your helper hold the trach in place. Remove the old trach ties and thread the new ones through the fastener tabs on each side of the trach. Secure them with their Velcro closures. Make sure that the neckband is flat against the skin, but not too tight. You should be able to slide a finger under the tie.

3. Clean the skin around the catheter

Since the area around the catheter can become covered in secretions, it can become a prime location for infection. Therefore, clean it regularly at least twice a day. To do so, wash your hands thoroughly. Mix mild soap and warm water in a bowl. Place the child in a comfortable position. Dip a washcloth into the soapy water and clean around the tracheostomy. When done, remove all traces of soap and pat the area dry. For dried secretions that are hard to remove, you may use a mix of equal parts water and hydrogen peroxide.

4. Change the tracheostomy tube

Typically, this should be done about once a week, unless the pediatrician recommends doing it more often. Doing this also requires assistance from someone else. To do so, wash your hands prior to starting. Remove the new trach tube from its packaging. Place the obturator in the trach tube and attach the trach ties. Lubricate the tip of the trach tube. Place the child on their back. Have your helper hold the new trach tube while you remove the old trach ties and trach tube. Wipe the skin around the opening with a wet washcloth and pat the skin dry. Gently insert the new tube. Listen and feel for air coming in and out. Secure the new trach ties.

5. Learn about feeding methods

Most children with a tracheostomy can continue to eat their meals normally. However, if your child’s vocal cords have been injured, they may have difficulty swallowing. Monitor them closely and inform the pediatrician if you notice any frustrations or complications. If you’re feeding a baby, keep them in the upright position during feedings and burp him or her frequently.

6. Encourage communication

Be aware of the fact that a tracheostomy may affect the child’s speech. Depending on how large the opening is, your child may be able to make sounds or speak. If they cannot communicate with you and he or she is old enough, you can use a small board to communicate in writing or use an electronic device. If your child is too young to be able to communicate, use an apnea monitor.

7. Take special care when bathing your child

Always bathe the child in shallow water. Cover the trach with a trach mask. Avoid splashing water into the trach. When washing the child’s hair, hold their head back while supporting his or her neck. Pour water over the head while keeping the trach area dry.

8. Become familiar with preventive care

If you live in a dry area, install a humidifier in your home. This will prevent the child from breathing in dry air, which can irritate his or her lungs. If the tracheostomy tube ever falls out, reinsert the tube immediately. In addition, if you’re going out with your child, pack a portable suction, another set of tracheostomy tube and ties, saline solution, trach lubricant, extra trach ties, and hand sanitizer. If you ever see bright red blood on the trach tube, this is a sign of damage to the child’s airways. Seek medical care immediately.

Contact Care Options for Kids For Pediatric Home Health Care

It can be hard to balance your time between work, home, and caring for a child who has a genetic disorder. Homecare providers offer the support you or your loved one needs.

That’s why our team of skilled professionals at Care Options for Kids are here to help. Our home care services offer support in the comfort of your home. We refer loving and competent caregivers to provide customized care for families – from a few hours a day to around-the-clock supervision. Contact us directly to speak with a home health care professional or request a free in-home assessment. Together we can determine the best plan of action to keep your loved ones happy and healthy.

If you are considering pediatric home health care services, contact the caring staff at Care Options for Kids. Call today at (888) 592-5855.