The Respiratory System
Reasons for a Tracheostomy
- A Blockage in the Upper Airway
If the upper airway is blocked, air cannot get into the lungs. The trach tube helps your child breathe.Paralyzed vocal cords may also block the upper airway. When the vocal cords do not open, air does not get through and the child cannot breathe. The trach tube lets the child breathe normally.Other conditions that may block the upper airway include polyps; narrowing of the trachea; or weak muscles in the trachea. When the muscles in the trachea are weak, the trachea closes and blocks airflow.
- Inability to Clear Mucus from the Lungs and Airway
Lungs make mucus. Mucus cleans the lungs by picking up tiny bits of dirt and dust. Cilia, which line the lungs, help the mucus carry the dirt and dust out of the lungs. This protects the lungs from irritation and infection.Some children are not able to cough mucus out of the lungs and airways. If mucus stays in the lungs, the child is more likely to get infections. The trach tube provides a way to help clear mucus from the lungs.
- Long-Term Help with Breathing
A trach tube is put in when a child has to be on a ventilator for a long time. Your child may have to use the ventilator at home after the trach is placed. There are many reasons why a child may need long-term help with breathing. You need to discuss this with your child’s doctor.
How a Tracheostomy Changes the Respiratory System
- Your child will not be able to cry or talk while the trach tube is in place. Air passes out of the lungs through the trach tube. It does not go through the nose and mouth, and does not pass over the vocal cords to make them vibrate.
- There are special devices that let a child talk with the trach tube in place. If your child can use one of these devices, the doctor or nurse will talk to you about it.
- Air that enters the lungs through the trach tube is not warmed, humidified, or cleaned. This air can irritate the lungs. You will learn how to protect your child’s lungs from cool, dry, or dirty air.
Choosing the Trach Tube
- The reason your child needs the trach
- The size of your child’s trachea
During the surgery, the doctor will put in the correct size and type of trach tube. Often the first trach tube has a cuff. The cuff is a filled balloon that seals off the air leak from the stoma. Right after the surgery, a trach with a cuff helps your child and the ventilator (breathing machine) work together to breathe.
Making the Decision about a Trach Tube
It is not easy to decide about a tracheotomy for your child. You may have mixed feelings about it. Ask your doctor and trusted advisors any questions you may have.
A tracheostomy may be temporary or it may be permanent. The doctors will explain your child’s specific needs to you before the surgery. When your child has recovered from surgery, the doctors review his needs again and discuss this with you.Sometimes a tracheostomy is permanent. Many children who have a tracheostomy might need to stay on a ventilator at home.
If you agree to a tracheostomy for your child, you will learn how to care for the trach, including:
- Cleaning the stoma
- Changing the trach ties
- Changing the trach tube
- Doing CPR with a trach
You will go to classes in the Family Resource Center. There, you will practice these skills on a doll. Plan to go to class right after the trach surgery and before the first trach change by the surgeons.