During the first week you may feel overwhelmed at the amount of care your child requires. This is because the tracheostomy is new and needs special attention at this stage. For this reason your child will be under constant supervision for the first two to three days after the operation. Children requiring respiratory support from a ventilator may have this level of nursing for much longer. As you become more familiar with the equipment and routines, you will feel more comfortable with the special care needed for the tracheostomy.

You may feel quite awkward during the initial period after the tracheostomy. You may feel that the nursing staff are becoming more familiar with your child’s everyday needs than you are. You will be encouraged to continue with their usual care like feeding and bathing as far as you feel able.

For the first seven days the opening in your child’s neck (stoma) will look red and inflamed. This is aggravated by the humidification (moistened air) which your child needs at this stage and also by the tube which can irritate and rub on the skin around the stoma. During this period the stoma site will need careful cleaning at least once a day. If it is very inflamed this will be done more often and the nurses may put a protective dressing around the stoma, behind the tracheostomy tube.

After about seven days the tube will be changed for the first time. You are advised not to observe. This is because the stoma (opening) is still new and may require attention. The stitches will be removed and then the area cleaned. Humidification may be stopped and the stoma site will continue to heal. Tape changing can then be done once a day and the stoma site cleaned when necessary.

There are many different types of tracheostomy tube and your child will be given one that most suits his or her needs. The tubes are usually made of a plastic material and are soft to touch. The tracheostomy nurse specialist and ENT team will discuss with you the most appropriate tube for your child. There are four main types of tube used for children and each is slightly different.

When you are used to watching the nursing staff looking after your child’s tracheostomy, you and your partner will be taught to look after the tracheostomy yourselves. A tracheostomy needs extra care because it is a much more direct route to the lungs and therefore the air moving into the lungs will not have the benefit of the warming, moistening and filtering effect of the nasal passages. It is more difficult for the child with a tracheostomy to clear secretions adequately by coughing so the tube needs special care to prevent it blocking with secretions. The tapes holding the tube in place will need changing daily or when they become dirty or wet. The tube will need to be changed regularly depending on the type.

Before you take your child home, at least one person in your household must be confident in the main activities involved in caring for the tracheostomy.

You may feel that this is an awful lot to learn, but we will make sure you are confident before you go home. Most parents feel like this but with practice they become experts in the care of their child. Every child is different and in time you will find a routine that suits you. Remember there is always someone here on the end of a telephone to advise and reassure you.