EBP Compendium: Summary of Clinical Practice Guideline
NHS Quality Improvement Scotland
Best Practice Statement: Caring for the Child/Young Person with a Tracheostomy
NHS Quality Improvement Scotland.
Edinburgh (Scotland): NHS Quality Improvement Scotland, 68 pages.
AGREE Rating: Recommended with Provisos
This guideline provides recommendations for the management of children and adolescents with a tracheostomy. This guideline is intended for healthcare professionals involved in the multidisciplinary care of these children.
- Assessment Areas
- “Where an impaired swallow is identified, additional appropriate investigations may be undertaken following Royal College of Speech and Language Therapy (RCSLT) clinical guidelines” (p. 10).
- There is little data available regarding the impact of tracheostomy on swallowing in the pediatric population; however, some factors that may impact swallowing are:
- Swallowing difficulties may be a result of a primary medical diagnosis.
- Children with isolated airway problems are not likely to present with swallowing problems.
- Children with long-term tracheostomies may present with pharyngeal stage swallowing impairment.
- Restricted upward laryngeal motion may reduce complete epiglottic closure by limiting laryngeal closure.
- Lack of airflow in the upper respiratory airway as a result of air diversion through the tracheostomy tube may lead to laryngeal desensitization and may impact co-ordinated laryngeal closure.
- Children receiving ventilator support may have reduced sucking, swallowing, and breathing coordination which may cause swallowing dysfunction.
- If the cuff is inflated, oral feeding should not be considered.
- Behavior, swallowing, and food intake may be affected by gastro oesophageal reflux.
- Assessment Instruments
- Clinical Examination
- “The presence of a tracheostomy tube may impair swallowing with increased risk of aspiration” (p. 10).
- Speech-language pathologists should assess swallowing, "including first gathering relevant information from the multidisciplinary team, and recognize when to involve the dietitian" (p. 10).
- "The assessment should be carried out along with the child/young person’s nurse” (p. 10).
- General Findings - “Multidisciplinary management offers an efficient and co-ordinated way of dealing with any nutritional or swallowing difficulty” (p. 10).
- Oral Motor Treatments - “The speech and language therapist should implement an oro-motor programme for the child/young person who is non-orally fed in order to normalize sensation and maintain and promote skills. A child/young person who is non-orally fed can become orally hypersensitive resulting in possible future behavioural feeding difficulties” (p. 10).
Access the Guideline
Added to Compendium: November 2011