When swallowing problems do occur, it is usually due to limited elevation of the larynx or poor closure of the epiglottis and vocal cords, which allows food or fluids into the trachea. An otolaryngologist and a speech pathologist can be consulted for an evaluation, which may include a videofluoroscopic swallowing study or other procedures to make sure the child's swallowing is safe. The speech pathologist may be able to develop ways to improve swallowing if there is a problem. Indications of a Swallowing Problem Difficulty or refusing to eat Over-reaction or no reaction to food the mouth Choking and coughing while eating or drinking Vomiting Evidence of food in tracheostomy secretions Excessive drooling Large amounts of watery secretions from trach Congested lung sounds Frequent respiratory infections If the child eats by mouth, it is recommended that the tracheostomy tube be suctioned prior to eating. This often prevents the need for suctioning during or after meals, which may stimulate excessive coughing and could result in vomiting.
Encouraging fluids is helpful for a child with a tracheostomy.
Increased fluid intake will thin and loosen secretions making coughing and suctioning easier. Avoid plastic bibs that may block the tracheostomy. If necessary, use a loose cotton bib or HME to prevent food from entering the trach tube. Watch toddlers closely so that they do not put food into trach tube. This will decrease the chance of aspiration.