Health
New Guidelines Help Parents Navigate Tracheostomy Decisions for Children

On October 22, 2025, the American Thoracic Society (ATS) published new clinical practice guidelines aimed at assisting parents and caregivers in making informed decisions regarding tracheostomy placement for children. This significant update seeks to alleviate the emotional burden faced by families and improve outcomes for young patients requiring respiratory support.
Guidelines Address Complex Decisions
A tracheostomy involves the surgical placement of a tube through an incision in the neck into the trachea, facilitating easier breathing. While this procedure can be life-saving and enhance the quality of life for some patients, it may not be beneficial for all. Dr. Christopher Baker, co-chair of the guidelines and director of the Ventilator Care Program at Children’s Hospital Colorado, emphasized the complexity of this decision. “A tracheostomy can save a life, lengthen a life, and improve the quality of life. However, this is not always true,” he stated.
The guidelines were crafted to provide clarity for both clinicians and caregivers, ensuring that they can collaborate effectively to determine the best course of action for each child. “We wrote these guidelines to help clinicians and family caregivers provide the best care possible,” Dr. Baker explained. “Ultimately, it is up to each provider-caregiver partnership to decide what is best.”
Parental Perspectives and Expert Recommendations
Feedback from caregivers is a central aspect of the new guidelines. Crystal Costante, a parent involved in the guideline development, expressed gratitude for the emphasis on family inclusion in care decisions. “The new guidance gives me a sense of hope and relief as a parent of a ventilator-dependent child with a tracheostomy,” Costante said. She noted that the guidelines foster trust and enhance communication between families and healthcare providers, leading to better safety and quality of life for children.
The expert panel that developed the guidelines included health professionals and parents, addressing key questions through the evidence-based Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. Three critical recommendations are highlighted:
“We recommend applying ethical principles (beneficence, nonmaleficence, autonomy, and justice) to guide shared decision-making about tracheostomy placement.”
This recommendation underscores the importance of ethical considerations in the decision-making process. Additionally, the panel advises that an awake and alert trained caregiver should always be present with children at risk of immediate complications related to tracheostomy placement.
Furthermore, for children with tracheostomies, clinicians are urged to conduct a complete airway evaluation prior to any attempt at decannulation. This evaluation should comprehensively assess the nasal passages, oral cavity, and various sections of the trachea and bronchi.
The ATS’s previous statement on chronic tracheostomy care was issued in 1999, making this the first clinical practice guideline in this area. Dr. Baker noted that while the guidelines aim to standardize care, implementing these recommendations may be challenging in resource-limited settings, including rural areas and low-income countries. A follow-up study is planned to explore the applicability of the guidelines in these contexts.
Since 2016, the ATS has published over 30 clinical practice guidelines covering a range of conditions, from allergies and asthma to tuberculosis and pulmonary infections. The Society is committed to enhancing guideline implementation tools to ensure that high-quality care is accessible to all.
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