Tracheotomy—Child

(Tracheostomy)

by Cynthia M. Johnson, MA

Definition

A tracheotomy is surgery to create an opening through the neck into the throat. The opening is called a stoma or tracheostomy. It may be temporary or permanent.

A tube called a tracheotomy tube will be inserted into the opening. Air may pass directly through this tube or tubing will be attached to a machine that helps with breathing.

Airflow Through a Tracheostomy

Reasons for Procedure

A tracheotomy is done to open a new pathway for air to move into the lungs. It may be needed in children who have damage or illness to the upper airways from things like:

Smoke or chemical inhalation, or burns
Infection
Nerve or muscle problems that affect the airway or breathing
Weak chest and diaphragm muscles
Narrowing of the airway just below the voice box
Abnormal structures of the head, neck, or airway
Foreign body obstruction
Trauma
Tumors

A tracheotomy may also be done if long-term mechanical ventilation is needed. It lets a child move, eat, drink, and speak while receiving ventilation. It can also lower the risk of breathing in foods and liquids.

Possible Complications

Problems are rare, but all procedures have some risk. The doctor will go over some problems that could happen, such as:

Excess bleeding
Problems from anesthesia, such as wheezing or sore throat
Infection
Damage to nearby structures, such as vocal cords, nerves, or esophagus
Lung injury
Problems with swallowing, speaking, or eating
An abnormal connection (fistula) to the esophagus or other structures

What to Expect

Prior to Procedure

The surgical team may meet with you to talk about:

Anesthesia options
Any allergies your child may have
Current medicines, herbs, and supplements that your child takes and whether they need to be stopped before surgery
Fasting before surgery, such as avoiding food or drink after midnight the night before
Tests that will need to be done before surgery, such as images of the airway and surrounding structures

Anesthesia

General anesthesia will be given. Your child will be asleep.

Description of the Procedure

An incision will be made in the skin of the neck. A section at the front of the windpipe will be removed. A tracheostomy tube will then be fitted into this opening in the windpipe. An inflatable cuff may be part of the tube. It would be used with mechanical ventilation to keep air going into the lungs and not leaking into the mouth. The skin will be closed with stitches or clips.

How Long Will It Take?

15 to 30 minutes

Will It Hurt?

Pain is common in the first few days. There may also be problems swallowing. Medicine and home care can help.

Average Hospital Stay

The usual length of stay is 1 to 5 days. If your child has any problems, they may need to stay longer.

Post-procedure Care

At the Hospital

Right after the procedure, the staff may:

Give medicine to ease pain and nausea
Take an x-ray to evaluate the tube
Check to make sure the tube is working as it should
Teach you and your child how to care for the tube
Teach your child how to speak and eat with the tube

During your child's stay, the hospital staff will take steps to lower your child's risk of infection, such as:

Washing their hands
Wearing gloves or masks
Keeping your child's incisions covered

There are also steps you can take to lower your child's risk of infection, such as:

Washing your hands often and reminding visitors and staff to do the same
Reminding staff to wear gloves or masks
Not letting others touch your child's incisions

At Home

It will take a few weeks to get used to the tube. Physical activity may need to be limited during this time. Your child will need help with daily activities and need to delay their return to school.

Call Your Child's Doctor

Call the doctor if your child is not getting better or has:

Signs of infection, such as fever and chills
Cough
Mucous that has a bad odor
Redness, swelling, excessive bleeding, or any discharge from the incision site
Pain that cannot be controlled with medicine
Shortness of breath
New or worsening symptoms

Call for emergency medical services right away if:

The tracheostomy tube falls out and you cannot replace it
Your child is having problems breathing through the tube

If you think your child has an emergency, call for medical help right away.

RESOURCES:

Family Doctor—American Academy of Family Physicians
https://familydoctor.org

The Society of Thoracic Surgeons
http://www.sts.org

CANADIAN RESOURCES:

Caring for Kids—Canadian Paediatric Society
https://www.caringforkids.cps.ca

The College of Family Physicians of Canada
http://www.cfpc.ca

References:

Mechanical ventilation. EBSCO DynaMed website. Available at: https://www.dynamed.com/procedure/mechanical-ventilation. Accessed September 8, 2021.

Tracheostomy and ventilator dependence. American Speech-Language-Hearing Association website. Available at: https://www.asha.org/public/speech/disorders/tracheostomies-or-ventilators. Accessed September 8, 2021.

Tracheostomy service. Johns Hopkins Medicine website. Available at: https://www.hopkinsmedicine.org/tracheostomy/about/index.html. Accessed September 8, 2021.

Last reviewed July 2021 by EBSCO Medical Review Board Kari Kuenn, MD
Last Updated: 9/8/2021

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