Tracheostomy Tube in Children
A tracheostomy tube is a medical device placed through a surgical opening in the neck directly into the windpipe (trachea) to help a child breathe. This guide provides practical information about pediatric tracheostomy tubes, their use, care, and safety measures for parents, caregivers, and healthcare professionals.
What is a Tracheostomy Tube?
A tracheostomy tube (often called a trach tube) is a curved hollow tube inserted through a stoma (surgical opening) in the front of the neck into the trachea. It creates an alternative airway when the normal breathing passage through the nose and mouth cannot be used or is blocked.
The tube allows air to enter the lungs directly, bypassing the upper airway. In children, these tubes are specially designed in smaller sizes to fit pediatric airways safely.
Purpose and Medical Uses
Tracheostomy tubes are used in children for several medical reasons:
- Long-term ventilator support for children who cannot breathe on their own
- Upper airway obstruction due to birth defects, tumors, or swelling
- Severe breathing problems from lung or neurological conditions
- Protection of the airway during prolonged unconsciousness
- Removal of secretions from the lungs in children who cannot cough effectively
- Chronic conditions requiring long-term airway management
Where Tracheostomy Tubes are Used
- Pediatric intensive care units (PICU)
- Neonatal intensive care units (NICU) for newborns
- General hospital wards
- Home care settings with proper training and support
- Long-term care facilities
- Rehabilitation centers
Types of Pediatric Tracheostomy Tubes
Based on Design
| Type | Features | Common Use |
|---|---|---|
| Cuffed Tubes | Has an inflatable balloon at the tip to seal the airway | Children on mechanical ventilation, prevents air leaks |
| Uncuffed Tubes | No balloon, allows some air to pass around the tube | Most common in children, allows speaking and more natural breathing |
| Fenestrated Tubes | Has opening(s) in the outer curve of the tube | Allows airflow through the vocal cords for speech |
| Non-fenestrated Tubes | No openings in the tube wall | Standard tubes for most children |
Based on Number of Parts
Single Cannula: One-piece tube, most common in infants and young children. Easier to insert and maintain.
Double Cannula: Has an outer tube and removable inner cannula. The inner part can be removed and cleaned without changing the entire tube. More common in older children.
Common Manufacturers and Materials
- Shiley - Pediatric and neonatal sizes, made of medical-grade PVC or silicone
- Portex - Blue Line Ultra and other pediatric ranges
- Bivona - FlexTend and TTS cuffed tubes for children
- Most tubes are made from silicone or polyvinyl chloride (PVC) which are safe, flexible, and well-tolerated
Parts of a Tracheostomy Tube
- Outer cannula: Main tube that stays in the trachea
- Inner cannula: Removable inner tube (in double cannula systems) for cleaning
- Obturator: Guide used only during insertion to prevent tissue damage
- Flange: Flat portion that rests against the neck
- Ties or holder: Secures the tube around the neck
- 15mm adapter: Connects to ventilator circuits or breathing equipment
- Cuff (if present): Inflatable balloon with pilot balloon and valve
How to Use: Step-by-Step Care Guide
Important: Tracheostomy care must be taught by trained healthcare professionals. Never attempt care without proper training. This guide is for educational purposes and reference after training.
Daily Tracheostomy Care
Step 1: Gather Supplies
Collect clean gloves, saline solution, clean gauze, tracheostomy ties or holder, suction catheter and machine, and any prescribed cleaning solutions.
Collect clean gloves, saline solution, clean gauze, tracheostomy ties or holder, suction catheter and machine, and any prescribed cleaning solutions.
Step 2: Hand Hygiene
Wash hands thoroughly with soap and water for at least 20 seconds. Put on clean gloves.
Wash hands thoroughly with soap and water for at least 20 seconds. Put on clean gloves.
Step 3: Suction if Needed
If the child has secretions, suction the tracheostomy tube before cleaning. Insert catheter gently without suction, then apply suction while withdrawing. Each suction should last no more than 5-10 seconds.
If the child has secretions, suction the tracheostomy tube before cleaning. Insert catheter gently without suction, then apply suction while withdrawing. Each suction should last no more than 5-10 seconds.
Step 4: Clean Around the Stoma
Using gauze moistened with saline, gently clean around the stoma site in a circular motion. Remove any dried secretions or crust. Pat dry with clean gauze.
Using gauze moistened with saline, gently clean around the stoma site in a circular motion. Remove any dried secretions or crust. Pat dry with clean gauze.
Step 5: Change Tracheostomy Dressing
Place a clean, pre-cut tracheostomy dressing (or split gauze) under the flange. Never cut regular gauze as loose threads can enter the airway.
Place a clean, pre-cut tracheostomy dressing (or split gauze) under the flange. Never cut regular gauze as loose threads can enter the airway.
Step 6: Check and Change Ties/Holder
Ensure ties are secure but not too tight. You should be able to fit one finger between the tie and the neck. Change ties if soiled, with two people if possible - one holding the tube while the other changes ties.
Ensure ties are secure but not too tight. You should be able to fit one finger between the tie and the neck. Change ties if soiled, with two people if possible - one holding the tube while the other changes ties.
Inner Cannula Cleaning (for double cannula tubes)
Step 1: Remove the inner cannula by unlocking and gently pulling it out.
Step 2: Clean with prescribed solution or warm soapy water using a small brush.
Step 3: Rinse thoroughly with sterile water or saline.
Step 4: Dry completely or use a spare clean inner cannula.
Step 5: Reinsert and lock the inner cannula securely.
Step 2: Clean with prescribed solution or warm soapy water using a small brush.
Step 3: Rinse thoroughly with sterile water or saline.
Step 4: Dry completely or use a spare clean inner cannula.
Step 5: Reinsert and lock the inner cannula securely.
Suctioning Procedure
- Measure catheter depth by placing catheter next to tube - mark the insertion length
- Use appropriate catheter size (should be half the tube diameter or less)
- Pre-oxygenate if needed, especially if the child is on oxygen
- Insert catheter without suction to the measured depth
- Apply suction while slowly withdrawing in a twisting motion
- Suction for maximum 5-10 seconds per attempt
- Allow child to rest and breathe between suctions
- Rinse catheter with sterile saline between attempts
Tube Change Procedure
Warning: Tube changes should only be performed by trained individuals. The first tube change after surgery is typically done by a doctor. Emergency services should be readily available during home tube changes.
Routine tube changes are typically performed weekly or as recommended by the medical team:
- Have two people present when possible
- Prepare new tube with ties attached and obturator in place
- Keep emergency equipment ready including a tube one size smaller
- Position child with neck slightly extended
- Remove old tube smoothly while supporting the neck
- Insert new tube with obturator, following the natural curve
- Remove obturator immediately and insert inner cannula if applicable
- Confirm placement by checking breathing and chest movement
- Secure ties immediately
Precautions and Safety Measures
Essential Safety Rules
Never leave a child with a tracheostomy unattended. Constant supervision or monitoring is essential.
- Always keep emergency equipment at bedside: spare tracheostomy tube (same size and one size smaller), obturator, suction machine, scissors, and emergency phone numbers
- Keep the head of the bed elevated 30-45 degrees when possible
- Never use powders, oils, or lotions near the stoma
- Avoid water entering the tracheostomy during bathing - use a shower shield or careful sponge bathing
- No swimming unless specifically approved by the medical team with special precautions
- Use humidification as prescribed to prevent secretions from becoming thick
- Maintain clean technique for all care procedures
Potential Complications and Dangers
| Complication | Signs | Action |
|---|---|---|
| Tube Obstruction | Difficulty breathing, noisy breathing, increased effort, low oxygen | Suction immediately, if unsuccessful remove inner cannula or change tube, call emergency services |
| Accidental Decannulation | Tube comes out completely | Keep stoma open, reinsert new tube immediately, use smaller size if needed, call for help |
| Infection | Redness, swelling, pus, fever, odor | Contact doctor immediately, may need antibiotics |
| Bleeding | Blood from stoma or in secretions | Minor bleeding is common, heavy bleeding requires immediate medical attention |
| Granulation Tissue | Extra tissue growth around stoma | Medical evaluation needed, may require treatment |
When to Seek Immediate Medical Help
Call emergency services immediately if:
- Unable to reinsert the tube after it comes out
- Severe breathing difficulty not relieved by suctioning
- Tube cannot be cleared by suctioning
- Heavy bleeding from the stoma
- Skin color changes (blue, pale, or gray)
- Child becomes unconscious
- Fever above 38.5°C (101.3°F) with other symptoms
Keeping the Device Safe and Clean
Storage and Equipment Maintenance
- Store spare tracheostomy tubes in clean, dry containers at room temperature
- Keep emergency kit accessible at all times - near the bed and portable for travel
- Replace disposable supplies regularly before expiration dates
- Clean reusable equipment according to manufacturer instructions
- Check suction machine function daily
- Maintain adequate stock of all supplies
Infection Prevention
- Hand washing before and after all care procedures is the most important prevention measure
- Use clean or sterile technique as instructed by your healthcare team
- Change dressings when soiled or at least once daily
- Keep the stoma area clean and dry
- Use each suction catheter only once, then dispose
- Avoid exposing child to people with respiratory infections
- Ensure caregivers are up-to-date with vaccinations including influenza
Equipment Checklist for Home Care
Essential Supplies:
- Tracheostomy tubes (current size and one size smaller)
- Suction machine with backup power source
- Suction catheters (correct size)
- Sterile saline or water
- Tracheostomy ties or holders
- Pre-cut tracheostomy dressings
- Clean gloves
- Scissors (for emergency tie cutting)
- Humidification system if prescribed
- Bag-valve-mask (Ambu bag) appropriate size
- Flashlight for examination
- Emergency contact numbers posted visibly
Living with a Tracheostomy
Communication
Children with tracheostomies may have difficulty speaking because air bypasses the vocal cords:
- Some children can speak by covering the tube opening briefly
- Speaking valves (Passy-Muir valve) can be used if appropriate
- Younger children may use sign language, picture boards, or electronic devices
- Speech therapy can help develop communication skills
Feeding and Nutrition
- Many children with tracheostomies can eat and drink normally
- Some may need modified textures or tube feeding
- Swallowing evaluation may be needed
- Keep the head elevated during and after feeding
Travel and Outdoor Activities
- Plan ahead and carry all necessary supplies
- Bring extra equipment for emergencies
- Carry medical information and emergency contacts
- Inform airlines or transport services in advance
- Use protective covering outdoors to prevent dust and insects
- Avoid very cold or dry air - use humidification
School and Social Activities
- Children with tracheostomies can attend school with proper support
- School staff should receive training in basic tracheostomy care and emergencies
- Develop an emergency care plan with the school
- Regular communication with teachers and school nurse is important
- Participation in most activities is possible with appropriate precautions
Frequently Asked Questions
How long will my child need a tracheostomy?
Duration varies widely depending on the underlying condition. Some children need it temporarily for weeks to months, while others require it long-term or permanently. Your medical team will regularly assess if and when the tube can be removed.
Can my child go to daycare or school?
Yes, many children with tracheostomies attend daycare and school. The facility must have trained staff and appropriate emergency protocols in place. Work with your healthcare team to develop a care plan.
How often should the tube be changed?
Routine changes are typically done weekly to monthly depending on the tube type and physician recommendations. The first change after surgery is done by a doctor, usually 5-7 days post-surgery.
What if the tube falls out?
Stay calm. Keep the stoma open with your finger if needed. Attempt to reinsert a new tube immediately using the same size or one size smaller. If unsuccessful within 1-2 attempts, call emergency services while continuing to keep the stoma open.
Can my child bathe or shower?
Yes, but with precautions. Water must not enter the tracheostomy. Use shower shields, careful sponge bathing, or shallow baths. Never submerge the tracheostomy in water.
Will my child be able to talk?
It depends on several factors including age, tube type, and underlying condition. Some children can talk by covering the tube, others may use speaking valves, and some need alternative communication methods. Speech therapy can help.
How do I know if the tube is blocked?
Signs include increased breathing effort, noisy breathing, visible secretions at the tube opening, low oxygen levels, and the child appearing distressed. Immediate suctioning is needed, and if ineffective, the tube may need to be changed.
Can my child sleep normally?
Children with tracheostomies can sleep, but require monitoring. Use a baby monitor or specialized equipment to track breathing and oxygen levels. Some children need nighttime humidification or ventilator support.
What supplies do I need to keep at home?
Essential supplies include spare tracheostomy tubes (same size and one smaller), suction machine and catheters, ties, dressings, saline, gloves, scissors, and emergency equipment. Keep at least one week's supply on hand.
Are there any activities my child cannot do?
Swimming and water activities require special precautions or may be prohibited. Contact sports may need protection. Otherwise, most activities are possible with appropriate safety measures and supervision.
How can I prevent infections?
Practice strict hand hygiene, use clean technique, change dressings regularly, keep the stoma clean and dry, avoid sick contacts, and follow your care routine consistently. Report any signs of infection immediately.
What should I tell babysitters or other caregivers?
Only trained individuals should care for a child with a tracheostomy. They need training in routine care, suctioning, emergency procedures, and when to call for help. Provide written instructions and emergency contacts.
Training and Support
Proper training is essential before taking a child home with a tracheostomy:
- Hospital-based training programs teach all aspects of care
- Practice sessions with supervision before discharge
- Written instructions and demonstration videos for reference
- Contact information for 24-hour medical support
- Support groups for families of children with tracheostomies
- Home nursing care may be available in some regions
- Regular follow-up appointments with specialists
Professional Resources and References
For additional information, consult these authoritative sources:
- American Academy of Pediatrics (AAP) guidelines on pediatric tracheostomy care
- Global Tracheostomy Collaborative resources and protocols
- Pediatric Airway Management textbooks by recognized experts in pediatric otolaryngology
- National organizations for specific conditions requiring tracheostomy (cerebral palsy, muscular dystrophy, etc.)
- Local children's hospital education materials and support programs
- Medical equipment manufacturers' instruction manuals
Always follow the specific instructions provided by your child's medical team, as care may vary based on individual needs.
Medical Disclaimer
This guide is provided for educational and informational purposes only and is not intended as medical advice. It should not replace professional medical consultation, diagnosis, or treatment. Every child's medical situation is unique, and tracheostomy care must be individualized based on specific medical needs and physician recommendations. Always seek the advice of qualified healthcare professionals regarding any questions about your child's tracheostomy care. Never disregard professional medical advice or delay seeking it because of information in this guide. In case of emergency, contact your local emergency services immediately. The information presented here is current as of the date of publication, but medical practices and recommendations may change. Regular consultation with your child's healthcare team is essential for safe and effective tracheostomy management.
This guide is provided for educational and informational purposes only and is not intended as medical advice. It should not replace professional medical consultation, diagnosis, or treatment. Every child's medical situation is unique, and tracheostomy care must be individualized based on specific medical needs and physician recommendations. Always seek the advice of qualified healthcare professionals regarding any questions about your child's tracheostomy care. Never disregard professional medical advice or delay seeking it because of information in this guide. In case of emergency, contact your local emergency services immediately. The information presented here is current as of the date of publication, but medical practices and recommendations may change. Regular consultation with your child's healthcare team is essential for safe and effective tracheostomy management.
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