Post tracheal treatment rehabilitation

Following treatment it is very important that all aspects of your child's development are addressed. 

Children with tracheal problems often need intensive, specialist rehabilitation for:

• swallowing problems
• voice difficulties

Swallowing is an activity that most of us do not even think about. However, it is a complex process that involves a number of nerves and muscles working together to stop any food or liquid entering the windpipe (trachea) and 'going down the wrong way'.

We all momentarily 'close' our airway and stop breathing as we swallow. To do this we must have good control over our breathing. When our breathing is disrupted for any reason it can be more difficult to co-ordinate the swallow and food or drink may enter the windpipe. This is known as aspiration. Regular aspiration can cause lung infections or pneumonia. Difficulty swallowing is known as dysphagia.

After a slide tracheoplasty, some children have difficulties swallowing. We think this is due to changes in co-ordination of breathing and swallowing, although research is ongoing in this area.

While children are in intensive care immediately after surgery we use a tube to feed them, called a naso-gastric tube. This means children can be fed without needing to swallow.

Once children are breathing on their own, a Speech and Language therapist (SLT) specialising in swallowing will carry out an assessment to check the safety of the swallow. This is a quick and simple test done at the bedside. The SLT will watch and listen to the child’s swallow. About 50 per cent of children having a slide tracheoplasty will then have an X-ray of their swallow called a videofluoroscopy.

The SLT will work with the rest of the team to make sure the child is feeding safely (and no food or drink is going down the wrong way). Most children will go home eating and drinking normally.

About 20 per cent of children will still have swallowing difficulties by the time they are ready to go home. This can usually be treated by using a thickening powder that can be added to drinks. Sometimes children will need a naso-gastric tube to help with feeding at home.

Any children with swallowing difficulties will be referred to a SLT in their local area or seen by a SLT as an outpatient at Great Ormond Street Hospital.

In most cases, swallowing difficulties that occur after a slide tracheoplasty get better without any other treatment within a couple of months.

The vocal cords sit in your voice box (larynx) at the top of your windpipe (trachea). To make voice, the two vocal cords come together and vibrate. As the air coming up from your lungs passes through the vibrating vocal cords, sound is made.

After having a breathing tube, a child’s voice can sound quieter or huskier than normal. This usually gets better within a couple of days. A SLT will check your child’s voice at the same time as they check swallowing.

The major nerve that causes the vocal cords to move is called the recurrent laryngeal nerve. This travels the length of the windpipe so, as a result, the nerve can get damaged during surgery to the windpipe.

Very occasionally we have found children have a vocal cord palsy after a slide tracheoplasty. This is where the recurrent laryngeal nerve has been damaged and means one of the vocal cords doesn’t move properly. This can lead to the voice sounding quiet and a little husky which doesn’t get better after a couple of days.