• A tracheostomy is an opening in the windpipe or trachea that you breathe through instead of breathing through the nose or mouth. Trach is a short way of saying tracheostomy.
• Your child's doctor created this small opening or "stoma" in the neck during surgery.
• The tracheostomy stoma allows air and oxygen to pass through the windpipe into the lungs.
• Excessive secretions are removed from the windpipe through the stoma.

Children need trach tubes for many different reasons. Your doctor has probably already told you the specific reasons for your child's tracheostomy. Often the tracheostomy is not permanent and can be removed when your child grows or when the problem is corrected and the trach tube is no longer needed.

Children with the following problems may need a tracheostomy to keep the airway open and help their breathing:

• Birth defects that affect the breathing
• Narrowing or scarring of the windpipe or breathing tubes
• Inability of the vocal cords to move normally
• An abnormality such as softening or collapse of the windpipe or bronchial tubes
• A need for a ventilator to assist breathing
• A disease that affects muscles that control breathing
• A disease that affects nerves that control breathing

A tracheostomy tube is a short, soft, flexible plastic tube that is placed into the windpipe through the stoma. It is smaller in diameter than the inside of your child's windpipe. The trach tube keeps the windpipe open so your child can breathe easily. When the trach tube is in place, you will not be able to hear your child cry or talk because the air travels out the stoma instead of through the vocal cords (where sound is made) and out the mouth. The amount of sound made is affected by the amount of air your child can breathe around the trach tube.

• Your child with a trach needs to be watched closely day and night.
• Your child must be attended to at all times by an adult caregiver who has been trained in suctioning, trach care, trach tie change and changing the trach tube.
• Your child must be attended to by an adult caregiver who has been trained in emergency trach care.
• All caregivers need to practice good hand washing before and after caring for your child to reduce your child's risk for infection.

Following surgery, your child will be admitted to a Pediatric Intensive Care Unit (PICU) for care. The doctor will perform the first trach tube change after five to seven days. Your child will be given medicine for pain and sedation and will help prevent the tube from being dislodged.

Sutures (stitches) are placed on each side of the new trach tube to help open the trachea and replace the tube if it would become dislodged. Your child's doctor will remove these sutures after five to seven days. A ventilator and oxygen may also be required to help your child's breathing.

Your child will require follow up medical care from the:

• Pediatrician for routine child care
• ENT doctor who performed the tracheostomy
• Pulmonary doctor in the Tracheostomy Clinic after discharge from the hospital

Your child will be ready to go home when:

• They are medically stable
• You and other caregiver(s) are fully trained in providing care
• Private duty home nursing care is in place

The trach tube does not prevent your child from learning how to speak. The amount of sound made is affected by the amount of air your child can breathe around the trach tube.

Because air is exhaled through the trach tube instead of the vocal cords, mouth and nose, your child's voice will be soft.

The size of the trach tube also affects the amount of sound your child can make. While in the hospital and after discharge, your child will receive speech therapy to help with speaking.

Because a trach tube affects the voice and loudness of speech, your child will go home on a POX monitor that senses their breathing pattern. The monitor will sound an alarm if your child has problems. Many families also use an intercom or baby monitor to hear their child.

Your child will go home on a home pulse oxymeter monitor. The purpose of an home pulse oxymeter monitor is to alert you if your child stops breathing or has frequent or long pauses in breathing.

The monitor will also alert you by alarming if the heartbeat goes above or below the normal range set for your child.

Many things may cause the monitor to alarm for apnea, or a fast or slow heartbeat. If the alarm sounds on the monitor:

1. Check to see if your child is breathing
2. Check your child's trach tube, oxygen tubing and ventilator tubing. Your child may need to be suctioned or need an emergency trach change
3. Notify your child's doctor that your child had a monitor alarm
4. If your child is not breathing, begin CPR and dial 9-1-1

The trach tube does not affect the way your child will eat food. However, some children who have trach tubes also have difficulty with swallowing and gastric reflux. Because of this, some children are at risk to aspirate (inhale) food into the airway.

If your child has feeding or swallowing difficulty, your doctor will discuss this with you and determine if it may be helpful to use tube feedings to prevent the risk for reflux or food aspiration.

The trach tube helps your child breathe better. It is important, however, that your child has the opportunity to participate in all the activities that other children do.

There are only a few activities that your child cannot participate in, like swimming. Your child cannot go swimming or be under water because water would go directly into the trach tube and into the lungs. You also need to take special care to prevent small particles, such as dust, sand and fibers from entering the trach tube and irritating the lungs.

Your child cannot be around people who are smoking since smoke is a lung irritant.

A granuloma is new tissue that grows in or around the tracheostomy stoma.

What causes it?

• Granulomas form due to inflammation during healing...this is normal
• The granuloma tissue has no feeling. The tissue has a lot of very small blood vessels called capillaries. The tissue will be pink and moist. The tissue is like a mucous membrane tissue and may bleed if irritated
• The granuloma can block the tracheostomy stoma opening if it grows too big

How is it treated?

A granuloma is treated with Silver Nitrate or other medications/treatments prescribed by the ENT doctors. The granuloma usually goes away in a few days with treatment.

A speaking valve is a special device used by children with a tracheostomy. It is placed on the end of the tracheostomy tube or in-line with the ventilator circuit. The child breathes in through the speaking valve and trach tube. Then the child breathes out through the vocal cords, mouth, and nose. This allows the child to use their voice and also improves the sense of smell.

Every child is different, but your child must meet the following criteria:

1. Medically stable with no urgent concerns being addressed by their doctors
2. The ear, nose and throat doctor along with their pulmonary doctor must confirm that they have an open airway above the level of their trach tube
3. No thick secretions that could get in the way of breathing or plug their trach tube
4. Alert with readiness to communicate and/or taste food for pleasure