Updated December 3, 2025

Tracheostomy is an opening surgically created through the neck into the trachea (windpipe). During the procedure to create the opening, known as tracheotomy, a tracheostomy tube (commonly called a trach) is inserted through the front of the neck into the trachea (windpipe) to allow air to pass in and out as the child breathes.

Pediatric otolaryngologists David Tunkel, M.D., and Jonathan Walsh, M.D., and pediatric pulmonologist Nicholas Jabre, M.D., M.S., answer questions that parents and caregivers may have when considering a tracheostomy as a treatment option for their child.

What are the reasons a child may benefit from a tracheostomy?

Tracheostomies may be considered when a child is unable to pass enough air into his or her lungs. This can happen at any age, even in babies, for a variety of reasons. A child’s medical team might recommend a tracheostomy if a child experiences:

• Congenital defects that limit airflow through the nose, mouth or throat, including those seen in craniofacial syndromes such as Treacher Collins, Crouzon and Pierre Robin syndromes.
• Neurologic impairments that affect normal breathing patterns or cause upper airway obstruction, such as cerebral palsy, neuromuscular disorders or congenital central hypoventilation syndrome.
• Bronchopulmonary dysplasia (BPD), a chronic lung condition that affects babies born prematurely. 
• Trauma to the airway.
• Airway blockages from tumors, infections or scarring. Prolonged intubation (placement of a breathing tube through the mouth) and need for mechanical ventilator support.

The medical team may recommend a tracheostomy if the child is unable to breathe on their own without the help of a mechanical ventilator (breathing machine). For example, some babies born prematurely may need a ventilator or oxygen assistance for several years or more. 

Ventilators also provide breathing support for children with chronic lung disease. A ventilator can be used together with a tracheostomy, but some patients with a tracheostomy do not need a ventilator. Walsh explains that a tracheostomy can help ease long-term ventilation, and it can assist with transitioning off of ventilator support.

Is a tracheostomy permanent?

“Tracheostomy is not usually permanent, but this depends on the reason for this procedure and whether it was addressed or if a child grows out of it,” Tunkel says. “Your child’s doctor will perform regular evaluations to determine when it’s time to safely remove the tube.” In some cases, Tunkel says, a child may need a long-term or permanent tracheostomy if he or she has chronic or worsening medical, pulmonary or neurologic conditions. Long-term care will be required from your family and your child’s medical team to help maintain a healthy tracheostomy.

Short-term Tracheostomy

Short-term tracheostomy is sometimes needed in cases of trauma to the head or multiple organs and systems, or to help with breathing after a surgery on the face and skull.

Some infants who have tracheostomy for craniofacial conditions, such as Pierre Robin sequence, can have the tracheostomy tube removed after corrective surgery for palate and jaw problems, or after months of growth.

Long-term tracheostomy

Long-term tracheostomy is often considered when a child has a severe neurologic disorder or the need for chronic ventilator support that is not expected to improve over time.

“Every child is different, and removal of the tracheostomy tube may not be possible for everyone,” Jabre says. “However, your child’s doctors want to work with you to meet your child’s specific needs and to help them reach their fullest potential. Parents make all kinds of caring choices for their children, and when considering tracheostomy for your child — whether temporary or permanent — the most important thing is to consider what is right for you as a family.”

Can a child talk with a trach?

The ability to talk with a trach depends on the child’s age and the size of the airway. For very young children, the tracheostomy tube size may be too big to allow airflow for speech. However, as the child gets older, the trachea and larynx get bigger, and the ability to speak improves. Assistive devices such as speaking valves or caps may be appropriate for some children.

Speaking Valves 

Speaking valves allow a child to exhale air out of their mouth and nose instead of through the tracheostomy tube, allowing the child to use their voice. There are many other benefits to a speaking valve, including improved swallowing, secretion management, and sense of smell and taste.

A cap is a device that allows a child to practice breathing in and out through their mouth and nose only, without relying on the tracheostomy, and is often used when the parents and health care team anticipate decannulation (removal of the trach) for the child. Parents should work closely with an ENT surgeon, pediatric pulmonologist and speech pathologist to determine which if these, if any, is right for their child. 

Can a child eat with a trach?

“There are many children who have a tracheostomy and have a normal diet,” Walsh says. “In some situations, tracheostomy helps facilitate feeding that would not otherwise be possible due to difficulty breathing.”

However, it is important to understand the reasons for the child’s tracheostomy. This will help determine restrictions and conditions for swallowing.

What are best practices for caring for a child’s tracheostomy?

It is important to maintain a clean, open airway, free of secretions and mucus. Regular tracheostomy care and maintenance include:

• Cleaning the skin and tracheostomy site
• Changing tracheostomy tube ties, which are bands that go around the child’s neck
• Changing the tracheostomy tube
• Suctioning the inside of the tube to remove secretions and mucus
• Being prepared for emergencies, such as accidental removal or blockage of the tracheostomy tube. Your health care team will educate you to prepare for these situations.

Can a tracheostomy get wet?

When swimming or bathing, it is important for children with a tracheostomy to avoid getting water into their trach, because the water may also enter their airway.

It’s common to have these questions and more about caring for a child with a tracheostomy. Your child’s care team will be able to provide the additional answers you need, as well as step-by-step instructions along the way to ensure you and your child are prepared for living with a tracheostomy tube.