Pediatric tracheostomy (also known as tracheotomy) is a surgical procedure that can help a child breathe by creating an opening in the windpipe.

Pediatric otolaryngologists — also known as ear, nose and throat doctors (ENTs) — David Tunkel, M.D. and Jonathan Walsh, M.D. explain what parents and caregivers should expect when their child needs a tracheostomy.

During the procedure, a tracheostomy tube (commonly called a trach) is inserted through the front of the neck into the trachea (windpipe) to allow air to pass in and out as your child breathes. Tracheostomy tubes come in many different sizes to accommodate people at all stages of life. The type of tracheostomy tube your surgeon uses is based on the size of the trachea and your child's specific needs.

Reasons for a Tracheostomy for Children

Pediatric tracheostomies are performed when a child is unable to pass enough air into his or her lungs. This can happen at any age, even in babies, for a variety of reasons. A surgeon might recommend the procedure if your child experiences:

• Congenital defects that limit airflow through the nose, mouth or throat, including craniofacial syndromes such as Treacher Collins, Crouzon and Pierre Robin Sequence
• Neurologic impairments that affect normal breathing or cause upper airway obstruction, such as cerebral palsy or congenital central hypoventilation syndrome
• Lung conditions such as chronic lung disease or subglottic stenosis
• Trauma to the airway
• Airway blockages (such as tumors or swelling from infections)
• Prolonged intubation (placement of a breathing tube through the mouth)

The doctor may also recommend a tracheostomy if your child is using a ventilator. For example, some babies who are prematurely born may need a ventilator or oxygen assistance for six months or more. As soon as your child is medically cleared, the surgeon will remove the trach.

Ventilators also provide breathing support for children with chronic lung disease. A ventilator can be used together with a tracheostomy, but some patients with a tracheostomy do not need a ventilator. Ventilators are also frequently used for patients with breathing tubes (intubation). Walsh explains that a tracheostomy can help ease long-term ventilation and can assist with transitioning off of ventilator support.

Is pediatric tracheostomy permanent?

"Tracheostomy is not usually permanent, but this depends on the reason for this procedure and whether it was addressed or if a child grows out of it," Tunkel says. "Your child's doctor will perform regular evaluations to determine when it's time to safely remove the tube." In some cases, Tunkel says, a child may need a long-term or permanent tracheostomy if he or she has chronic or worsening medical, pulmonary or neurologic conditions. Long-term care will be required from your family and your surgeon to help maintain a healthy trach.

Short-term tracheostomy is sometimes needed in cases of trauma to the head or multiple organs and systems, or to help with breathing after a surgery on the face and skull.

Some infants who have tracheostomy for craniofacial conditions, such as Pierre Robin Sequence, can have the tracheostomy tube removed after corrective surgery for palate and jaw problems, or after months of growth.

Can a child talk with a trach?

The ability to talk with a trach depends on your child's age and the size of the airway. For very young children, the tracheostomy tube size may be too big to allow airflow for speech. However, as your child gets older, the trachea gets bigger, and the ability to speak improves. Assistive devices such as speaking valves or caps may be appropriate for some children.

"At Johns Hopkins, our pediatric otolaryngologists, respiratory therapists and speech-language pathologists work together and across teams to optimize your child's speech and language development," Walsh explains.

Can a child eat with a trach?

"There are many children who have a tracheostomy and have a normal unrestricted diet," Walsh says. "In some situations, tracheostomy helps facilitate feeding that would not otherwise be possible due to difficulty breathing."

However, it is important to understand the reasons for your child's tracheostomy. This will help determine restrictions and conditions for swallowing.

Caring for a Child with a Tracheostomy

It is important to maintain a clean, open airway, free of secretions and mucus. Regular tracheostomy care and maintenance include

• Cleaning the skin and tracheostomy site
• Changing tracheostomy tube ties, which are bands that go around your child's neck
• Changing the tracheostomy tube
• Suctioning the inside of the tube for secretions and mucus

Keeping a Child's Trach Dry

When swimming or bathing, it is important for children with a tracheostomy to avoid getting water into their trach, because the water may also enter their airway.

Your care team will provide step-by-step instructions to ensure your child is safe after a tracheostomy.