WARNING: The information in this section is meant as a general guide for parents and caregivers with certain problems related to children with tracheostomy using a simple non-fenestrated, cuffless tracheal cannula. It is not intended to replace the recommendations of your child’s healthcare team.

Discuss your child’s unique needs with the healthcare team, including WHO and WHEN to contact when problems arise.

 

Fever with or without general malaise: ≥ 38⁰C rectal or ≥ 37.5⁰C buccal or ≥ 37.5⁰C armpit

General irritability, poor appetite, fatigue or wanting to sleep more than usual (lethargy)

One or more of these symptoms of breathing difficulties: shortness of breath, trouble breathing or noisy breathing; breathing more quickly; chest pain; coughing more than usual or has a weaker cough; faster heart rate than usual; chest retractions and/or nasal flaring; decreased oxygen saturation compared to their normal values; purple or gray lips, tongue or fingertips (cyanosis); clammy skin\cold extremities; changes to behavior either fatigue or irritability; more comfortable breathing when sitting up; extends their neck and head backwards to take in a breath

One or more of these symptoms: decreased urination; increased thirst; dry lips and mouth; faster heart rate than usual; weight loss

One or more of these symptoms: coughing more frequently - yellow, green, pink or blood tinged secretions - secretions are thicker - secretions are more than usual - secretions have a bad odor - labored breathing - breathing more quickly - chest pain - fever (≥ 38⁰C rectal or ≥ 37.5⁰C oral or ≥ 37.5⁰C underarm) - irritability - loss of energy - loss of appetite/refusal to eat

Blood-tinged secretions

Resistance or impossibility of tracheal cannula reinsertion

Accidential decannulation: cuffless tracheal cannula partially or completely out

Bleeding from inside the tracheostomy or around the tracheostomy

Introduction of water into the tracheostomy

Skin around the tracheostomy site irritated (redness, edema, itchiness, burns, bad odor, oozing, presence of red pimples, small sores or bleeding and/or tracheostomy dressing is wet and soiled)

Skin around the neck irritated (redness, edema, itchiness, burns, bad odor, oozing, presence of red pimples, small sores or bleeding)

One or more of these symptoms: coughs and/or choking during meals - saliva more abundant than usual - secretions are more abundant after meals - secretions resemble the liquids or food that was recently ingested - traces of food are found during suctioning of tracheal secretions - eating difficulties or refusal to eat - vomiting during or right after a meal

Vomiting

 

Do not hesitate to refer to your child’s healthcare team for any questions or for specific advice related to your child’s condition.

When to consult your healthcare team

General state of health

When your child has any of the following symptoms:

  • Fever (≥ 38⁰C rectal or ≥ 37.5⁰C oral or ≥ 37.5⁰C armpit).
  • General irritability, poor appetite, fatigue or wanting to sleep more than usual (lethargy).
  • Signs and/or symptoms of breathing difficulties:
    • Short of breath, trouble breathing or noisy breathing,
    • Breathes more quickly,
    • Chest pain,
    • Coughs more than usual or weaker cough,
    • Heart rate faster than usual,
    • Chest retraction and/or nasal flaring,
    • Oxygen saturation monitor indicates that your child has a decreased oxygen saturation compared to their normal values,
    • Purple or gray lips, tongue or fingertips (cyanosis),
    • Clammy skin\cold extremities,
    • Changes to behavior either fatigue or irritability,
    • More comfortable breathing when sitting up,
    • Extends their neck and head backwards to take in a breath.
  • Signs and/or symptoms of dehydration:
    • Decreased urination,
    • Increased thirst,
    • Dry lips and mouth,
    • Faster heart rate than usual.

Secretions

The secretions:

  • have different colour (yellow, green, pink or blood-tinged secretions) or contain blood.
  • are thicker.
  • are more than usual and need to be suctioned more frequently.
  • are foul smelling.
  • have presence of traces of food when suctioned.
  • are more during or after meals.
  • look like recently ingested liquids or foods.

Tracheal cannula

  • Insertion of a new cannula is difficult or impossible.
  • The cannula is partially or completely out.

Tracheostomy

  • Bleeding in or around the tracheostomy.
  • Water has entered the tracheostomy.
  • Skin around the tracheostomy is irritated.
  • Dressing is wet or soiled with blood.
  • The skin on the neck is irritated.

Feedings

Your child:

  • coughs or chokes often when eating.
  • has trouble eating or drinking.
  • has a poor appetite and refuses to eat.
  • vomits during or right after meals.

Your child’s healthcare team will take the opportunity during your child’s follow-up appointments to review your child’s care and equipment. Adjustments will be made as required.

Do not hesitate to refer to your child’s healthcare team for any questions or for specific advice related to your child’s condition.