Paeds · respiratory-sleep-and-airway
Tracheostomy care and emergencies
Also known as Paediatric tracheostomy · Blocked tracheostomy tube · Displaced tracheostomy tube · Accidental decannulation · Tracheostomy tube change · Tracheostomy decannulation
Fellowship guide to paediatric tracheostomy care and emergencies: the tube types and their parts, the physiology of an airway that bypasses the upper airway, routine humidification and suctioning, the blocked and displaced tube emergency algorithm with oxygen to both the face and the stoma, safe first and routine tube changes, the structured decannulation pathway, and recognition of the technology-dependent child at home.
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Target exams
Red flags
- A child with a tracheostomy in respiratory distress or desaturating whose tube may be blocked or displaced
- Increasing resistance to ventilation or an inability to pass a suction catheter down the tracheostomy tube
- Accidental decannulation of a fresh tracheostomy before the tract has matured, with high risk of a false passage on reinsertion
- Bright red bleeding or a sentinel bleed from the stoma suggesting a tracheo-innominate artery fistula
- A child whose colour and effort improve when oxygen is given to both the face and the stoma, confirming an obstructed or displaced tube
- A collapsed child with a tracheostomy where no one has removed a speaking valve, cap, or inner cannula
- A tracheostomy-dependent child presenting without their emergency equipment, spare tubes, or a resuscitation plan
Life stages
Care settings
Clinical exam formats
Board mappings
- Recognises a blocked or displaced tracheostomy tube as an airway emergency
- Knows to give oxygen to both the face and the stoma while help is called
- Understands why a fresh tracheostomy is more dangerous than a mature one
- Leads the paediatric tracheostomy emergency algorithm and secures the airway
- Plans safe routine tube changes and a structured decannulation pathway
- Coordinates home care, education, and equipment for the technology-dependent child
- Initial management of a child with a blocked or displaced tracheostomy tube
- Recognition and first response to accidental decannulation
- Counselling families of a child going home with a tracheostomy
- Bedside assessment of the child with a tracheostomy in distress
- Decision-making around tube change, reinsertion, and escalation
- Communication of a tracheostomy emergency plan with the family and team
- Level 1: Recognises tracheostomy distress and calls for help
- Level 2: Works through the blocked and displaced tube algorithm
- Level 3: Leads tracheostomy emergencies, changes, and decannulation
- Tube types, parts, and sizing for paediatric tracheostomy
- Physiology of the bypassed upper airway and stoma tract maturation
- Emergency algorithm and complications of paediatric tracheostomy
- Assessment and stabilisation of the child with a tracheostomy
- Communication of home tracheostomy care and safety-netting
- Structured approach to the tracheostomy emergency
- Recognition and management of paediatric tracheostomy emergencies
- Routine tracheostomy care, tube changes, and decannulation
- Care of the technology-dependent child and family
- Emergency response to a blocked or displaced tracheostomy tube
- Safe tube change technique and complication recognition
- Coordination of multidisciplinary and home tracheostomy care
- Canadian approach to paediatric tracheostomy care and emergencies
- Decannulation readiness assessment and pathway
- System and family supports for tracheostomy-dependent children
Overview & Definition
A child with a tracheostomy who suddenly looks distressed, desaturates, and stops moving air is one of the most time-critical emergencies in paediatrics, because the airway that keeps them alive is a short plastic tube that can block or fall out in seconds. The reassuring truth is that almost every tracheostomy emergency comes down to two problems, a blocked tube or a displaced tube, and a simple, rehearsed algorithm resolves the great majority of them. The clinician who keeps that algorithm in mind, and who remembers to oxygenate both the face and the stoma, can rescue a child that an unfamiliar responder would lose. [1]
A tracheostomy is a surgically created opening through the anterior neck into the trachea, held open by a tube that bypasses the mouth, nose, pharynx, and larynx and delivers air directly to the lower airway. Children receive one for three broad reasons: to relieve upper airway obstruction, to provide long-term mechanical ventilation, and to allow safe pulmonary toilet in a child who cannot clear secretions. Increasingly, the paediatric tracheostomy patient is a medically complex, technology-dependent child who will live at home with the tube for years. [3]
Tracheostomy care spans the everyday and the catastrophic. Routine care means humidifying the inspired air the nose no longer warms, suctioning secretions, cleaning the stoma, and changing the tube on a schedule. Emergency care means recognising within seconds that the tube is blocked or out, working through a fixed sequence, and reinserting or removing the tube to restore a patent airway. Both halves are examinable, and both save lives. [4]
References12ShowHide
- [1]Doherty C Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies. Anaesthesia, 2018.PMID 30062783
- [2]McGrath BA Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies. Anaesthesia, 2012.PMID 22731935
- [3]Campisi P Pediatric tracheostomy. Seminars in Pediatric Surgery, 2016.PMID 27301607
- [4]Fuller C Update on Pediatric Tracheostomy: Indications, Technique, Education, and Decannulation. Current Otorhinolaryngology Reports, 2021.PMID 33875932
- [5]Komori M Update on pediatric tracheostomy. Auris Nasus Larynx, 2024.PMID 38520972
- [6]Newton M Pediatric Tracheostomy-Related Complications: A Cross-sectional Analysis. Otolaryngology-Head and Neck Surgery, 2022.PMID 34520273
- [7]Raynor T Pediatric tracheostomy decannulation: what's the evidence? Current Opinion in Otolaryngology and Head and Neck Surgery, 2023.PMID 37751378
- [8]Xiao L Pediatric tracheostomy tube decannulation with or without polysomnography: A PRO-CON debate. Pediatric Pulmonology, 2022.PMID 34825785
- [9]Kohn J Standardization of pediatric tracheostomy care with "Go-bags". International Journal of Pediatric Otorhinolaryngology, 2019.PMID 30913503
- [10]Hebbar KB Mortality and Outcomes of Pediatric Tracheostomy Dependent Patients. Frontiers in Pediatrics, 2021.PMID 34017809
- [11]Chorney SR Timing the First Pediatric Tracheostomy Tube Change: A Randomized Controlled Trial. Otolaryngology-Head and Neck Surgery, 2021.PMID 32928049
- [12]De Jong R Pediatric Tracheostomy. StatPearls [Internet], 2026.PMID 32809457