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.

 

One or more of these symptoms: coughing more frequently, yellow, green, pink or blood tinged secretions, secretions are thicker, secretions are more abundant 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

One or more of these respiratory distress symptoms: labored breathing, more comfortable in a sitting position or with head elevated than in a lying down position, rapid, noisy or wheezy breathing, shallow breathing, secretions are more abundant than usual, weak cough, indrawing (retraction of the skin over, under and in between the ribs), use of accessory muscles to help with breathing, nasal flaring (enlargement of the nostrils during breathing), extension of the neck backwards to try to breathe in air, continuously crying, agitation, anxiety, irritability, scared look on your child’s face, marked sweating, pale skin, blue color of lips and nail beds

Resistance or impossibility of tracheal cannula reinsertion

Tracheal cannula falls out, partially or completely, accidental decannulation: cuffless tracheal cannula partially or completely out

Blood-tinged secretions

Bleeding from inside the tracheostomy or around the tracheostomy

Introduction of water into the tracheostomy

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, vomiting right after a meal

Vomiting

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)

 

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

When to consult your healthcare team

Breathing

  • Your child is short of breath or has trouble breathing.
  • He coughs more than usual.
  • He breathes more rapidly and shallowly.
  • Your child is more comfortable breathing when sitting up or if his head is elevated.
  • He extends his neck and head backwards to take in a breath.
  • You observe chest retractions and nasal flaring.

Secretions

  • Color is different (yellow, green, pink or blood tinged secretions), or contain blood.
  • Are thicker.
  • Are more abundant than usual and need to be suctioned more frequently.
  • Are foul smelling.
  • Presence of traces of food when secretions are suctioned.
  • Secretions are more abundant during or after meals.
  • The secretions resemble 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.
  • He has trouble eating or drinking.
  • He has a poor appetite and refuses to eat.
  • He vomits during or right after meals.

General condition

  • Your child has chest pain.
  • He produces a lot of saliva and has trouble swallowing it.
  • He has a fever (≥ 38⁰C rectal or ≥ 37.5⁰C oral or ≥ 37.5⁰C axillary).
  • He is generally unwell (eg, crying, agitation, anxiety, looks scared, excessive sweating, pale skin, bluish colored  lips and nailbeds, irritable, no energy, etc).

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.