Tracheostomy and Feeding: 

The first steps into eating is massage

Most children with trachs have them because there is an underlying problem with breathing.  If you do not have the comfort of normal breathing you can't eat.  (Think about how difficult it is to eat when you have tight nasal congestion, or think how difficult it would be to eat after you just ran a fast sprint.) Therefore, the trach helps give children more comfort and safety breathing, but it does not necessarily allow for normal breathing and swallowing coordination.  In fact, the trach can anchor the natural neck movements and laryngeal movements needed for swallowing.  In some instances a child may require a tracheostomy for their airway lifeline, only to develop dyspahsia.

There are various ways to help strengthen swallowing and loosen the neck muscles to aid in breathing and swallowing.

 1.  Gently massage the neck muscles.

              Tight neck muscles pull the collar bone and rib cage up, making breathing more  labored, but they will also put the chin and larynx down.  We want these trached children to be able to move freely and without pain.  Many parents have told me they are concerned about massaging around the neck because the tracheostomy is there.  It is very important to not compromise the tracheostomy, but don't be afraid of the child's neck muscles. 

2.  Gently massage under the jaw

               With one hand softly supporting the jaw, take your thumb and massage the underside of the jaw.  You will gently press up and out toward the chin.  You want the tongue to move as well inside the mouth with the up and out motion of your thumb.


3.  Loosen the jaw with massage.

                  Start by gently massaging the muscle at the back of the jawbone.  Use circular motions forward and back, then in opposite directions.  When the child's jaw joint is loose enough, you can carefully move the jaw side to to side.  Place your thumb on the muscle in the back of the jaw with soft pressure.  Then with your other hand use the thumb and forefinger at the chin and push ever so carefully to the side.  Repeat on the other side.  


 The most important thing to remember is not to be afraid of touching the neck and trach area.  Those muscles need to be loosened and massaged.