New Guidelines Help Families Decide on Tracheostomy for Children

Parents and caregivers grappling with the decision to pursue a tracheostomy for their child now have new guidance to assist them. The American Thoracic Society (ATS) released a clinical practice guideline on October 22, 2025, aimed at helping families and clinicians navigate the complexities involved in this critical decision. Published in the American Journal of Respiratory and Critical Care Medicine, the guideline addresses the emotional weight of choosing this treatment option.

A tracheostomy involves placing a tube through an incision in the front of the neck into the windpipe, facilitating easier breathing for patients. While this procedure can significantly enhance life quality, it is not universally beneficial. Dr. Christopher Baker, co-chair of the guideline and director of the Ventilator Care Program at Children’s Hospital Colorado, noted the dual nature of tracheostomies. “A tracheostomy can save a life, lengthen a life, and improve the quality of life. However, this is not always true,” he stated. The choice to proceed with a tracheostomy can be daunting for families, making the new guidelines particularly timely.

The ATS developed these guidelines as a resource for pediatric pulmonologists, critical care clinicians, and rehabilitation specialists. A collaborative panel, led by Dr. Baker and Dr. Reshma Amin from The Hospital for Sick Children, included both health professionals and family members. The panel aimed to address six critical questions regarding tracheostomy care, employing the GRADE framework to ensure evidence-based recommendations.

One family member involved in the guideline development, Crystal Costante, expressed her appreciation for the new guidance. “It gives me a sense of hope and relief as a parent of a ventilator-dependent child with a tracheostomy,” she remarked. Costante emphasized the importance of including families in healthcare decisions, stating that clear guidance fosters trust and enhances communication among caregivers and healthcare providers.

The guidelines include essential recommendations to improve care quality. One recommendation advocates for applying ethical principles—beneficence, nonmaleficence, autonomy, and justice—in shared decision-making about tracheostomy placement. Another emphasizes that a trained caregiver should always be present with children at risk of complications related to the procedure. Additionally, a complete airway evaluation is recommended before attempting to decannulate a child with a tracheostomy.

This publication marks the first time the ATS has issued a clinical practice guideline specifically addressing pediatric tracheostomy care since its previous statement in 1999. Enhanced scientific rigor in these guidelines aims to provide a comprehensive approach to care for children with chronic tracheostomies.

While the guidelines are a significant step forward, Dr. Baker acknowledged potential challenges in implementing these recommendations, particularly in resource-limited settings such as rural areas or lower-income countries. He indicated that further studies are underway to assess the applicability of these guidelines in diverse contexts.

The ATS has established itself as a leader in developing clinical practice guidelines across various medical conditions, having published over 30 since 2016. These efforts reflect a commitment to improving patient care and outcomes through increased collaboration between healthcare providers and families. As families confront the complexities of tracheostomy decisions, this new guidance aims to support informed, shared decision-making that prioritizes the well-being of young patients.