Impact of Tracheostomy on Developmental Milestones and Clinical Approaches for Healthcare Providers

Improvement in both medical technology and resuscitation techniques has led to increased survival rate for infants and children with medical complexities.¹  Many of these children require tracheostomy tube placement as well as additional medical intervention.  While there is data available that discusses life-threatening complications for this patient population, there is little data discussing risk of delayed developmental milestones.² Tracheostomy can have a negative effect on multiple facets of milestone development, which requires providers to implement strategies to negate these effects. Speech language pathologists, occupational therapists, physical therapists, respiratory therapists, and nurses all have a vital role in ensuring that children with tracheostomies can achieve these developmental milestones.

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Speech

A tracheostomy tube compromises normal upper-airway airflow, and in neonates this disruption can delay maturation of the upper airway, contributing to the high incidence of speech delay.³ Early intervention by a speech-language pathologist (SLP) is essential and one important consideration is use of speaking valves to help restore airflow to the upper airway. This allows for restoration of upper airway functions and enables vocal cord vibration and facilitates speech development. Speaking valves, such as the Phon Assist with adjustable resistance for smaller children, can be a valuable tool. This valve allows for decreased resistance as compared to a one-way speaking valve, which may allow for partial upper airway airflow early after tracheostomy placement. Restoring airflow into the upper airway sooner could have a positive outcome in speech development for this population.³ Speech language pathologists and respiratory therapists have a vital role in implementing these strategies.

Language

As significant language milestones happen between 3-6 months of age, it is important that neonates have the opportunity to practice early vocalizations including gurgling and babbling.⁴ Restoring upper airway airflow as soon as possible can help to enable children audibly voice.³ This gives them the opportunity to be able to progress along the developmental pathway. As mentioned above, utilizing a speaking valve to restore airflow to the upper airway can facilitate language development in this patient population. As with speech development, SLP intervention is paramount. The healthcare team can support children’s language development by incorporating SLP recommendations.

Swallowing

Swallowing can be difficult for patients of any age with a tracheostomy, which can be multifactorial and early speech-language pathology intervention is crucial. The primary diagnosis and/or additional comorbidities that necessitate tracheostomy tube placement can contribute to dysphagia. In addition, physical impediment of the tracheostomy tube preventing normal movement of the larynx, impairments in the glottic closure reflex, and reduced airflow to the upper airway leading to sensorimotor changes contribute to swallowing difficulties.⁵ Restoring airflow to the upper airway is a key therapeutic strategy, and speaking valves can help achieve this by improving subglottic pressure buildup and enhancing upper-airway sensation.⁵ Although research remains limited, available data suggest that most pediatric patients with a tracheostomy can take at least some oral feeds; however, additional studies are needed.⁵

Motor Ability

Motor development is extremely important for children, especially in the first year of life, when infants go from lying, to rolling, to crawling, to walking.⁶ Physical therapists and occupational therapists can have significant impact in helping children with tracheostomies develop motor milestones. Children are at significant risk of delayed motor development when they spend significant time in the ICU, particularly after critical illness or surgery such as tracheostomy.⁷ Early mobility has been shown to decrease the risk of readmission and decrease length of stay. Mobility programs are often easier to implement when fewer lines and tubes are required, and reducing external equipment can greatly enhance a child’s ability to move. One option for patients with a tracheostomy is the use of an HME (heat and moisture exchanger) instead of an external active humidification system, which requires tubing connected to a wall source and can significantly restrict movement.⁸ While HMEs provide appropriate warmth and humidity to inspired air, they also provide improved mobility when compared to traditional humidification delivery via tracheostomy collar, which could allow for improved motor development⁸. Mobility is an important milestone that must be prioritized for pediatric patients with tracheostomy.

The negative impact on developmental milestones related to tracheostomy placement cannot be denied. However, there are opportunities to help combat these negative effects. Healthcare providers can take an active role in implementing strategies to help children with tracheostomies achieve developmental milestones.

Upcoming event:

Join us on January 13, 2026 for a webinar exploring all these options and more, "Impact of Tracheostomy on Developmental Milestones and Clinical Approaches".

References:
1. Guirguis F, Chorney SR, Wang C, Felicity Lenes-Voit, Shah GB, Mitchell RB, et al. Nationwide tracheostomy among neonatal admissions – A cross-sectional analysis. International Journal of Pediatric Otorhinolaryngology. 2021 Nov 15;152:110985–5.
2. Joseph RA, Evitts P, Bayley EW, Tulenko C. Oral Feeding Outcome in Infants with a Tracheostomy. Journal of Pediatric Nursing. 2017 Mar;33:70–5.
3. Chang J, Sidell DR. Tracheostomy in Infants in the Neonatal Intensive Care Unit. NeoReviews. 2020 May 1;21(5):e323–34.
4. Mayo Clinic Staff. Language development: speech milestones for babies. Mayo Clinic Healthy Lifestyle: Infant and Toddler Health. Language development: Speech milestones for babies - Mayo Clinic
5. Luu K, Belsky MA, Harish Dharmarajan, Kaffenberger TM, McCoy JL, Cangilla K, et al. Dysphagia in Pediatric Patients with Tracheostomy. 2021 Jun 18;131(5):457–62.
6. CDC. CDC’s Developmental Milestones [Internet]. Learn the Signs. Act Early. 2025. Available from: https://www.cdc.gov/act-early/milestones/index.html
7. Lehner, D. C., & Sadler, L. S.. Toddler Developmental Delays After Extensive Hospitalization: Primary Care Practitioner Guidelines. Pediatric nursing. 2015 Sept-Oct; 41(5), 236–242
8. Kearney A, Norris K, Bertelsen C, Samad I, Cambridge M, Croft G, et al. Adoption and Utilization of Heat and Moisture Exchangers (HMEs) in the Tracheostomy Patient. Otolaryngology-Head and Neck Surgery. 2023 May 10;169(5):1374–81.