If your child has a tracheostomy, refer to the appropriate section.

If your child has a tracheostomy, refer to the appropriate section.

Mouth care:

• Your child’s mouth should be cleaned at least twice a day.
• If your child has no teeth, use a small face cloth or a gauze dampened with water and rolled around your index finger, to gently rub your child’s gums front to back.
• Once teeth start to appear, brush your child’s teeth after each meal and at bedtime. Since young children have a tendency to swallow toothpaste instead of spitting it out, use only the size of a small grain of rice in children under 2 years old and the size of a small pea in children up to 6 years old. Use this time to also gently massage their gums with the toothbrush.
• As your child matures, teach and supervise brushing of the teeth.
• Apply, if required, a hydrating lip balm.

Nasal hygiene:

• In all children, secretions, along with bacteria and viruses collect in the nose. Keeping your child’s nose clean helps prevent lung infections.
• In infants and children who are unable to blow their noses, saline drops are often used to clean the nose.
• Refer to your child’s healthcare team for the technique and the frequency of nasal care recommended for your child, including the procedure for the preparation of homemade saline solution and safe storage.
• The use of saline nasal drops is especially important if your child requires nasopharyngeal suctioning.

If your child has a tracheostomy, refer to the appropriate section.

• Ensure that your child is well hydrated, especially during hot weather or if your child is unwell and has a fever, vomiting or diarrhea. These conditions cause thicker secretions. Adequate hydration will allow for easier aspiration of secretions and a more effective cough.
• Verify with your healthcare team the quantity of liquids necessary for your child according to the state of health.
• If your child has a tracheostomy, refer to the appropriate section.

• Your child may participate in daily activities according to ability, endurance and underlying conditions.
• Position your child in the most comfortable position possible to facilitate breathing and aspiration of secretions. If your child has a tracheostomy, refer to the appropriate section.

• Always check to see if your child requires suctioning prior to leaving home or starting activities.
• Always have on hand a “travel kit” when leaving your home containing:
  • suction catheters
  • a portable suction device
  • suction tubing
  • a canister to collect secretions
  • connecting tubing (if pertinent)
  • solutions to lubricate and clean the suction catheter (sterile water or cooled boiled water)
  • solutions to rinse the suction catheter (hydrogen peroxide 3%), if needed
  • containers for the solutions
  • alcohol swabs
  • non steriles gauze compresses
  • paper tissues (to wipe away excess secretions)
  • a manual mucus trap device (that can be used without battery or electrical power).
• Have a list on hand of the contents of this kit so it can be easily restocked. Confirm with your healthcare team how often you should verify supply and status, including expiry dates of equipment and materials.
• Keep a resource list close at hand with the names and telephone numbers of hospital, doctors, other members of your child’s healthcare team and equipment providers. Make sure you know how to contact these resources outside of regular hours and during vacations.
• Before leaving on a trip:
  • make sure you have a document from the healthcare team describing your child’s condition and your child’s needs regarding aspiration of secretions and a complete list of medications;
  • bring enough supplies to last for the duration of the trip and add a bit extra as a reserve;
  • make sure to ask if equipment providers and other resources are available at your destination in the event of equipment failure or other healthcare need;
  • take the climate of your destination into consideration because the relative humidity of the ambient air could modify the quantity and the consistency of your child’s secretions.
• For travel by airplane:
  • contact the airline company to inquire about their policy concerning the transport of medical equipment;
  • keep all medical equipment and supplies with you in the cabin.
• If your child has a tracheostomy, refer to the appropriate section.

Emergencies:

• Always have a telephone nearby in case of an emergency. Make sure your cell phone is charged at all times. When you go out, bring what you need to charge the phone, when necessary (cable with charger and portable Power Bank charger).
• Discuss with your child’s healthcare team whether your child requires monitoring by a trained and competent individual capable of intervening, as needed; during the day, night or at all times.
• If your child has a tracheostomy, refer to the appropriate section.

Humidity:

• Your child needs to live in an environment with adequate humidity so that secretions are easier to clear.
• Unless there is a medical restriction, keep your child well hydrated, increasing your child’s intake as needed.
• Avoid overheating the house in winter and use an air conditioner in the summer to maintain humidity in your home.
• The recommended relative humidity in the home, measured with a hygrometer, should be between 40 to 50%.
• If your home air is too humid (55% and more), install a dehumidifier and clean it every week in order to prevent the presence of mold in the air that your child breathes.
• If your home air is too dry (less than 40%), the following daily habits can help increase the moisture in your home:
  • do not activate the exhaust fan when you cook or boil water;
  • avoid using an air conditioner in the summer;
  • keep the bathroom door open when you shower;
  • minimize the use of electric heaters, wood burning stoves and fireplaces during the winter;
  • eliminate carpeting and rugs in the home.
• With your child’s healthcare team, discuss ways in which the level of humidity can be optimised in the air your child breathes for comfort and to aid in secretion mobilisation and clearance (eg, use of a portable humidifier filled with tap water, increasing humidity through other methods, etc).

Air quality:

• Clean air, with reduced dust, dirt and pollens can reduce the need for aspiration of secretions.
• Avoid all exposure to traditional or electronic cigarette smoke or vapor, especially at home.
• Clean and regularly change filters on the air conditioners.
• In your child’s proximity, avoid:
  • accumulation of dust, presence of rugs, upholstered furniture and home accessories that are difficult to clean (eg, heavy drapery);
  • dust from renovations;
  • wood burning heating systems (stove or fireplace);
  • excessive pollution (eg, smog, heavy traffic, strong winds).
• In your child’s room:
  • use pillows cases, sheets, and blankets made of washable synthetic material (hypo-allergenic);
  • sheets that are very soft and fluffy with fibers (eg, flannel sheets) are not recommended: they attract dust;
  • wash bedding in hot water every week in order to destroy dust mites;
  • dry bedding in a dryer if your child is allergic to pollen.
• If your child has a tracheostomy, refer to the appropriate section.

Prevention of infections:

• Always wash your hands before providing care to your child and have your child wash his hands before and after all meals and frequently during the day.
• If you have a cold, the flu or another respiratory infection, use non sterile gloves and wear a mask when providing care to your child.
• If your child has a tracheostomy, refer to the appropriate section.

Suction catheter replacement frequency:

• If used regularly and well maintained (see Maintenance and cleaning of medical supplies and equipment, below):
  • a flexible suction catheter may be used for up to 24 hours; change every day or according to the frequency recommended by your healthcare team;
  • a suction device such as Yankauer suction tip or Little Sucker® should be replaced every 2-4 weeks or according to the frequency recommended by your healthcare team;
  • a BBG nasal aspirator should be replaced every 7 days.
• All catheters should be replaced if secretions remain visible inside the catheter, despite proper cleaning or if the catheter is damaged in any way.
• If your child has a respiratory infection, the catheters may require more frequent replacement; follow the recommendations of your child’s healthcare team.

Maintenance and cleaning of medical supplies and equipment:

• Always refer to the manufacturer’s recommendations and those provided by your healthcare team; the healthcare team will consider the specific characteristics of your child to make the most appropriate recommendations. In general, these are the most commonly recommended practices:
• Suction device:
  • each week or more often, if necessary: clean the outer surfaces of the device with a soft cloth or a damp cloth; use a small amount of dish washing soap. Dry the surfaces using a clean cloth.
• Suction catheter:
  • after each aspiration:
    • suction sterile water or cooled boiled water to thoroughly rinse and clean the inside of the catheter so that no visible secretions remain;
    • if secretions are difficult to remove from inside the catheter, suction a small amount of hydrogen peroxide 3% followed by cooled boiled water or sterile water;
    • once well rinsed, dry the interior of the catheter by aspirating air; this prevents the growth of bacteria;
    • clean the outside of the catheter using an alcohol swab and let it air dry;
    • store the cleaned and dried catheter in the envelope that it came in, with a cap (if applicable) or in a clean, dry container;
    • if you are using a container for storage, clean it using the high heat setting on the dishwasher, at least once daily.
  • each week (suction device such as Yankauer suction tip or Little Sucker®):
    • aspirate soapy water, then rinse using sterile or boiled water;
    • once well rinsed, dry by aspirating air; obstruct the suction valve if present;
    • let air dry and then store as usual.
• Canister to collect secretions:
  • daily or when the canister is 3/4 full:
    • empty contents into the toilet;
    • wash the canister with warm soapy water;
    • rinse with warm water and let air dry;
    • reattach to the suction device.
  • each week:
    • disassemble the canister parts, if applicable;
    • rinse the canister and parts under warm running water;
    • soak the canister and parts in warm soapy water; use mild dish washing soap;
    • clean the inside of the canister using a soft cloth or a soft bottle brush to remove any adherent secretions;
    • rinse with warm water and let air dry;
    • reattach to the suction device.
  • if needed (for persistent odours even after appropriate cleaning): soak the canister in a 50% vinegar, 50% water solution for 20 to 30 minutes and then rinse well or replace the canister.
• Suction tubing:
  • after each aspiration:
    • ensure that there are no retained secretions inside the tubing; if secretions are present, rinse the tubing by suctioning sterile water or cooled boiled water;
    • if secretions in the tubing persist, suction hydrogen peroxide 3% followed by cooled boiled water or sterile water;
    • if you are unable to remove the secretions, replace the tubing.
  • each week:
    • aspirate soapy water followed by rinsing with cooled boiled water or sterile water;
    • dry the tubing by aspirating air;
    • let the tubing air dry and then store as usual.
  • each month or at the frequency recommended by your healthcare team: replace the tubing.
• Containers for cleaning and rinsing solutions (boiled water or sterile water and hydrogen peroxide 3%):
  • after each use: rinse containers with water and let air dry.
  • daily: clean containers with warm soapy water, rinse well with water and let air dry.
• Daycare and school:
  • Your child’s healthcare team will evaluate your child’s needs and will support you in the planning of integration to daycare or to school.
  • Advise school staff of the treatment and care that your child requires.