New Guidelines Help Families Decide on Tracheostomy for Children

Parents and caregivers navigating the emotional challenges of deciding whether a tracheostomy is the best treatment for their child now have new guidance. The American Thoracic Society (ATS) published a clinical practice guideline on October 22, 2025, aimed at assisting families and clinicians in making informed decisions regarding this complex procedure. The guideline appears in the latest issue of the American Journal of Respiratory and Critical Care Medicine.

A tracheostomy involves surgically placing a tube through the front of the neck into the windpipe, enabling easier breathing for patients. According to Christopher Baker, MD, co-chair of the guideline and director of the Ventilator Care Program at Children’s Hospital Colorado, “A tracheostomy can save a life, lengthen a life, and improve the quality of life. However, this is not always true.” He emphasized the necessity of careful consideration, noting that in some cases, the procedure may not provide the intended benefits and could even lead to complications.

The new guidelines stem from a collaborative effort led by Dr. Baker and Reshma Amin, MD, director of Sleep Medicine and Long-Term Ventilation Programs at The Hospital for Sick Children. This expert panel included health professionals and family caregivers who addressed critical questions regarding tracheostomy care for children.

Guidelines Enhance Family-Centered Care

The guidelines are intended for pediatric pulmonologists, critical care clinicians, and rehabilitation specialists, providing a framework for high-quality, family-centered care. One parent, Crystal Costante, expressed her relief at the new guidance, stating, “It shows that healthcare providers are recognizing the importance of including families as true partners in care.”

The emphasis on shared decision-making is crucial, as families often face overwhelming choices. Costante noted that clear and consistent guidance helps build trust, improves communication, and facilitates better collaboration between caregivers and healthcare providers.

The guidelines outline several key recommendations. Among them is the application of ethical principles—beneficence, nonmaleficence, autonomy, and justice—in shared decision-making about tracheostomy placement. This recommendation is classified as strong, although it comes with very low certainty of evidence.

Additionally, the guidelines recommend that a trained caregiver be present with children at risk of immediate complications due to tracheostomy, reinforcing the need for vigilant monitoring.

Comprehensive Approach to Decision Making

Another critical recommendation involves performing a complete airway evaluation before attempting to remove the tracheostomy tube. This evaluation should assess various parts of the airway, including the nose, throat, and lungs. This recommendation also received a strong endorsement, albeit with low certainty of evidence.

The ATS has previously issued statements on chronic tracheostomy care, but this marks the first comprehensive clinical practice guideline on the subject. Dr. Baker acknowledged the importance of rigorous scientific and methodological frameworks in developing these guidelines.

While the recommendations aim to improve care across diverse healthcare settings, he recognized that implementation may be challenging in areas with limited resources, such as rural regions or low- to middle-income countries. To address this, the ATS plans to conduct a follow-up study to explore how these guidelines can be effectively applied in various contexts.

Since 2016, the ATS has published over 30 clinical practice guidelines across a range of conditions, including asthma, tuberculosis, and other pulmonary infections. These guidelines are part of the society’s broader commitment to advancing pulmonary health and improving patient outcomes through evidence-based practices.

As families and healthcare providers begin to adopt these new guidelines, the hope is that they will lead to better decision-making processes, ultimately resulting in improved care and quality of life for children requiring tracheostomies.