New Guidelines Announced for Pediatric Tracheostomy Care

UPDATE: New guidelines released today, October 22, 2025, by the American Thoracic Society (ATS) aim to transform how clinicians and families navigate the challenging decision of whether a tracheostomy is the best treatment for children. This pivotal development seeks to alleviate the emotional burden faced by caregivers, enhancing decision-making for better patient outcomes.

The guidelines were published early online in the American Journal of Respiratory and Critical Care Medicine, emphasizing the need for a collaborative approach between healthcare providers and families. A tracheostomy—a tube surgically inserted into the windpipe—can be life-saving but may also pose risks, making informed choices critical.

Dr. Christopher Baker, co-chair of the guideline panel and director of the Ventilator Care Program at Children’s Hospital Colorado, stated, “A tracheostomy can save a life, lengthen a life, and improve quality of life. However, this is not always true.” He stressed that the guidelines are designed to empower caregivers in making informed decisions tailored to their child’s needs.

Highlighting the emotional impact, Crystal Costante, a parent on the panel, shared her relief as a caregiver of a ventilator-dependent child. “The new guidance gives me hope. It shows that health care providers recognize the importance of including families as partners in care,” she said. This collaborative model aims to build trust and improve communication, ensuring that families feel valued in the decision-making process.

The expert panel, led by Dr. Baker and Dr. Reshma Amin from The Hospital for Sick Children, utilized the evidence-based GRADE framework to develop key recommendations. Three vital guidelines include:

1. Ethical principles should guide shared decision-making regarding tracheostomy placement.
2. A trained caregiver must always be present with children at risk of complications related to tracheostomy.
3. A comprehensive airway evaluation is necessary before any decannulation attempts.

This publication marks the first clinical practice guideline from the ATS on pediatric tracheostomy care since their last official statement in 1999. The new framework emphasizes scientific rigor and a family-centered approach, vital for improving care quality.

Dr. Baker acknowledged challenges in implementing these guidelines in resource-limited settings, stating, “We realize some recommendations may be difficult to implement in rural areas or low/middle-income countries.” He confirmed that a follow-up study is in progress to assess the adaptability of these guidelines in such environments.

As the healthcare community absorbs these significant updates, the ATS continues to be a leader in developing clinical practice guidelines, having published over 30 since 2016 on various respiratory conditions.

The urgency of these guidelines cannot be overstated, as they promise to reshape the landscape of pediatric respiratory care, ensuring families have the necessary tools and support to make life-altering decisions for their children.

For the complete list of recommendations, visit the ATS website and stay tuned for more updates on this critical topic that impacts countless families worldwide.