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Tracheostomy
Background
A tracheostomy is an artificial opening into the trachea (windpipe) usually between the second and fourth tracheal rings. It is held open by a tracheostomy tube. A tracheotomy refers to the actual surgical 'cutting' into the trachea and a tracheostomy refers to the actual hole and the tube that sits into it.
Usually the decision to perform a tracheostomy is reached as a result of many investigations and tests. However, on some occasions, the need to perform a tracheostomy is the result of an acute upper airway emergency.
Indications for tracheostomy in the paediatric population differ somewhat from the adult population. A tracheostomy will ensure a patent (open) airway when the child's condition results in an obstruction causing a narrowed upper airway. Some children may require long or short term mechanical support from a ventilator, and some may require it to protect the lower airways from aspiration.
A child with a tracheostomy requires constant close observation and careful suctioning to keep the tube clear and to minimise undesirable effects.
There are different types of tracheostomy tubes available and the child should be given the tube that best suits its needs. The frequency of these tube changes will depend on the type of tube the child has and may possibly alter during the winter or summer months. Practitioners should refer to specialist practitioners and/or the manufacturers for advice.
Tracheostomies may be permanent or temporary. A temporary tracheostomy will be indicated until the child's medical condition stabilises or has been surgically corrected. Once it has been established that the tracheostomy is likely to be in place for a period of time, plans for community care will be started. A home care programme will be discussed with the child and family so that carers are sufficiently trained in all aspects of tracheostomy care before discharge from hospital.
Inheritance patterns and prenatal diagnosis 
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