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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. (2008).
Edinburgh (Scotland): NHS Quality Improvement Scotland, 68 pages. 
AGREE Rating: Recommended with Provisos

Description:
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.

Recommendations:

  • Assessment/Diagnosis

Assessment Areas

Swallowing/Feeding

  • “The presence of a tracheostomy tube may impair swallowing with increased risk of aspiration” (p. 10). Speech-language pathologists should 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).
  • “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.
  • Treatment

Swallowing/Feeding

  • 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).

Keywords:
Tracheostomy

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