Paediatric tracheostomy is usually an essential procedure to preserve life, or to allow a patient to function in the community. However, the effect of tracheostomy on the developing child - care requirements, lack of voice, impaired swallow, constant risk of decannulation or blockage and so forth - have profound effects that are inadequately understood. This study from Sheffield looks at 25 families (about a third of those eligible) with children with tracheostomies (or recently decannulated). The age range of patients follows that of clinic practice, with a predominance of younger children. All indications for tracheostomy were included, from those requiring continuous ventilation to those with pharyngeal airway obstruction and those with glottic and subglottic stenosis. Age-specific quality of life measures looking at social, emotional, physical and cognitive functioning were used, with children encouraged to self-report their opinions where possible.
The outcomes show worse quality of life than the normal population, which could be expected, but also a worse quality of life than comparable chronic diseases. The authors particularly consider childhood malignancy, type 1 diabetes, and renal failure requiring dialysis – all of which have comparable or even greater care requirements and impacts on health in the long term.
This fascinating finding emphasises the particular effects that tracheostomy has in a child – specifically social isolation. The authors recommend psychosocial support for such patients to be provided routinely, and after reading this article it is hard to disagree.