Tracheostomy & Feeding

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0 height="100%"><tr> <td valign="top" width=200 BGCOLOR="#FFCC80" TEXT="#080000" bgproperties="fixed" background="1088e8e3.jpg"> <div> <IMG SRC="10995810.png" border=0 width="149" height="129" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B><IMG SRC="075b6900.jpg" border=0 width="182" height="144" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <div> <A HREF="id37_m.htm#what_are_the_issues_that_need_to_be" TARGET="TRLX_Middle" TITLE="Tracheostomy Feeding"><U><B>What Are The Issues?</B></U></A></div> <bR> <div> <A HREF="id37_m.htm#preparation_for_oral_feeding_" TARGET="TRLX_Middle" TITLE="Tracheostomy Feeding"><U><B>Preparation for Oral Feeding </B></U></A></div> <bR> <div> <A HREF="id37_m.htm#pointers_for_feeding_your_child_" TARGET="TRLX_Middle" TITLE="Tracheostomy Feeding"><U><B>Pointers for Feeding Your Child </B></U></A></div> <bR> <div> <A HREF="id17.htm" TARGET="_top" TITLE="About Tracheostomy"><U><B>Click to return to About Tracheostomy</B></U></A></div> </td> <td valign="top" BGCOLOR="#FF9900" TEXT="#080000" bgproperties="fixed" background="10e00c82dwnjbj.jpg"> <div> <I> <A NAME="top"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></I></div> <div> <I>Tracheostomy & Feeding</I></div> <div> Children require tracheostomies for a variety of reasons. A baby may require a tracheostomy because of poor respiratory function. Some need them because of bronchopulmonary dysphagia with long-term ventilator support. Others with conditions such as subglottic stenosis or tracheomalacia may have tracheostomies that provide airway support for reasonably well-functioning lungs.</div> <bR> <div> Children with tracheostomies can receive different levels of respiratory support. Some children with tracheostomies require a ventilator to provide CPAP (continuous positive airway pressure); others just need intermittent breaths of positive pressure. Still others do not need ventilators at all but do need moistened air with or without oxygen through their trach collars. Many children with trachs need no extra oxygen or moist air. These children may need suctioning periodically until they learn to cough well jnough to clear the airway.</div> <bR> <div> whether the child needs a ventilator, the amount of extra oxygen needed, and the underlying condition of the child's lungs strongly influence the safety of oral feedings and the approach taken in teaching these children.</div> <div> Many children who require the extra breathing support provided by a tracheostomy can eat by mouth. Care must be taken to be sure it is medically safe to do so. This decision is made by thorough evaluation from the pulmonary doctor and feeding team.</div> <bR> <DIV ALIGN="LEFT"></DIV> <div> [<A HREF="#top" TITLE="Tracheostomy Feeding"><U>top</U></A>]</div> <bR> <div> <FONT SIZE="2" COLOR="#000000" FACE="Arial" ><B> <A NAME="what_are_the_issues_that_need_to_be"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B></FONT><B>What Are the Issues that Need to Be Analyzed When Considering Feeding a Child with a Tracheostomy?</B><B> </B></div> <bR> <div> Is it medically safe to feed your child by mouth? Only your child's pulmonary team can answer this through careful medical evaluation. </div> <bR> <div> Is it medically safe to feed your child by mouth? Only your child's pulmonary team can answer this through careful medical evaluation. </div> <bR> <div> <B>1) </B>How healthy are your child's lungs? </div> <div> <B>2)</B> Does your child have the lung power to sustain oral feeding? </div> <div> <B>3)</B> Does your child have the endurance to take a whole feeding without too much fatigue? </div> <div> <B>4)</B> Does your child need extra oxygen to get through awhole feeding? </div> <div> <B>5)</B> How are your child's sucking abilities? Did your child have the ability to suck before the trach was placed?      </div> <div>     Has your child practiced sucking since the trach was placed? </div> <div> <B>6)</B> Does your child remember how to suck, or has the trach placement interfered with this developmental skill? </div> <div> <B>7)</B> Can /our child swallow in a coordinated and safe way, directing the food into the stomach and not the lungs? </div> <div> <B>8)</B> Can you be sure there is no aspiration? </div> <div> <B>9)</B> Can your child coordinate the sucking, swallowing, and breathing skills needed for good oral feeding? Good co-ordination of these three skills is necessary to be sure food is swallowed without aspiration and without too much effort. </div> <div> <B>10)</B> What type of oral experiences has your child had, and how has the child reacted to those experiences? </div> <div> Children who have been intubated or generally have a variety of unpleasant experiences by mouth may become overly sensitive in and around the mouth area. They may be scared as nipples, spoons, and cups approach their faces.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > it, Mouth, practice biting, and practice moving the tongue in ways necessary for eventual eating by mouth. </FONT></div> <div> Work on sucking. Your child's feeding therapist will give you ideas on ways to help your baby learn or relearn to suck.</div> <bR> <DIV ALIGN="LEFT"></DIV> <div> [<A HREF="#top" TITLE="Tracheostomy Feeding"><U>top</U></A>]</div> <bR> <div> <B> <A NAME="preparation_for_oral_feeding_"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>Preparation for Oral Feeding </B></div> <bR> <div> Help your child practice sucking on fingers or pacifiers. Until you are given the go-ahead to start feeding your child by mouth, you should still give your child practice in sucking fingers or a pacifier. This sucking, though not taking in food, still stimulates the mouth and helps keep your child in practice for sucking and touch in the mouth.</div> <div> Provide pleasant touch in and around the mouth. Play games in and around your child's mouth with fingers, nipples, spoons, finger puppets, and toys. Your child needs to think of the mouth as a fun place for touch. So often children with many medical problems have had mostly unpleasant procedures around the mouth. Show your child the fun side of oral play.</div> <bR> <div> Encourage mouthing toys. The normal mouthing or chewing of fingers and toys is a great way to have children provide their own pleasant oral touch. Mouthing also provides the child with lots of self-directed touch around the it, Mouth, practice biting, and practice moving the tongue in ways necessary for eventual eating by mouth. </div> <div> Work on sucking. Your child's feeding therapist will give you ideas on ways to help your baby learn or relearn to suck.</div> <DIV ALIGN="LEFT"></DIV> <div> [<A HREF="#top" TITLE="Tracheostomy Feeding"><U>top</U></A>]</div> <bR> <div> <B> <A NAME="pointers_for_feeding_your_child_"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>Pointers for Feeding Your Child </B></div> <bR> <div> 1) Start feeding your child with a trach by mouth only when you have medical approval to do so. Supervision by a feeding specialist may be necessary as you and your child make the transition to oral feedings.</div> <bR> <div> 2) Go slowly. Let your child have some control. Children will let you know if they are willing to try a little liquid by mouth or if strained foods are preferred. Some children prefer dry cereals and crackers first. All of these decisions depend on your child's feeding skills, age, motivation, and medical condition. </div> <bR> <div> 3) Some people recommend starting with food that has been dyed so you can tell if it is being misdirected into the trach instead of the esophagus. </div> <bR> <div> 4) Have your child wear a bib to cover the trach so spilled liquid and food do not enter the trach. A plastic bib, though better at keeping liquid out, may interfere with breathing through the trach. A cotton or bigger-weave fabric may be better. </div> <bR> <div> 5) Be sure your child is upright with head in a tucked chin position. This position is usually best for directing swallows into the esophagus instead of the lungs. Teach coughing. Children who have tracheostomies usually learn to clear their own trachs by coughing rather than needing continued suctioning. They learn this by imitating you and as you encourage or reinforce their own attempts. Suction before you start and as needed throughout the meal. Stop and discuss the situation with the doctor if you suction any of the food or liquid being fed. If your child is one of those who thinks touch around and in the mouth is no fun and who becomes scared with the presentation of tastes, you will definitely want to contact a feeding specialist to help you work out ways to make tastes more fun. When children are scared they are more likely to coordinate their swallows poorly. </div> <DIV ALIGN="LEFT"></DIV> <div> [<A HREF="#top" TITLE="Tracheostomy Feeding"><U>top</U></A>]</div> <div> <B>Remember!</B></div> <bR> <div> Moving from tube feeding to oral feeding when your child has a tracheostomy can be complicated. Your child's pulmonary doctors and feeding team will help you through the process. Ask when you have questions! The more you know about the trach and the feedings, the more confident and the better advocate you will be. </div> <bR> <div> Resource</div> <div> Wolf, L. S, and R. P. Glass. 1992. Feeding and swallowing disorders in infancy: Assessment and management. Tucson, AZ: Therapy Skill Builders.</div> <bR> <bR> <bR> <bR> <bR> </td> </tr></table></body>