Do children with tracheostomy have difficulty with speech?
Children with tracheostomy have difficulty producing voice due to the changes in airflow that occur when a tracheostomy tube is placed. When a tracheostomy tube is placed, airflow typically flows in and out through the tracheostomy tube. There will be a lack of airflow around the tracheostomy tube and through the upper airway. Therefore, voicing is impaired.
Due to the lack of sufficient airflow and limited voicing, children with tracheostomy may present with speech delays, articulation disorders, phonological disorders, and difficulty with breathing and speech coordination.
Can a child with a tracheostomy speak?
Children with a tracheostomy may have the ability to speak. Speaking may happen by generating enough airflow around the tracheostomy tube in order to pass through the vocal folds. Occlusion of the tracheostomy tube is the most effective way to produce voicing with a tracheostomy tube. Occluding the tracheostomy tube can occur with digital occlusion, a speaking valve, or capping. If present, the cuff of the tracheostomy tube must be completed deflated. A speech-language pathologist with expertise in working with those with tracheostomy can help to decide which strategy is best.
Digital occlusion, or finger occlusion, is a technique where a clean finger (usually with a glove) is placed at the end of the tracheostomy tube. It may be easiest for the individual with tracheostomy to breathe if the tube is only occluded on exhalation.
A speaking valve such as the Passy-Muir Tracheostomy & Swallowing Valve may also be used to help with speech. A speaking valve can improve infection control when compared to digital occlusion. It is also a hands free approach to speech. The speaking valve is placed at the end (hub) of the tracheostomy tube. Air flows in through the tracheostomy tube and exhaled air flows around the tracheostomy tube, through the vocal folds and out the upper airway for speech.
Capping is another technique to occlude the tracheostomy tube for speech. It is more difficult to breathe with a cap in place compared to a speaking valve. It is recommended to first begin with a speaking valve prior to capping.
Speech Therapy Techniques for Tracheostomy
Kids with tracheostomy may need to ease into occlusion of the tracheostomy tube. First, digital occlusion may be best in order to determine if there is adequate airflow around the tracheostomy tube. A speaking valve may be trialed by a clinician who is competent in placement. Children with tracheostomy who are beginning to use a speaking valve often have difficulty adjusting to the change in airflow. It can be a frightening time to learn how to breathe through the vocal folds and out the upper airway. Children may also have difficulty learning to use their upper airway for speech.
Music can be a fun distraction to using a speaking valve as many children love music. Research has shown that music can have a positive effect on speech development and may reduce anxiety for those on mechanical ventilation .
Songs for Kids with Trachs
Finding Your Voice– Songs for Kids with Trachs is a song set with a choice of either a USB or download of 15 songs that focus on helping children achieve vocalization through imitation and verbal turn-taking. Also included in the set are 3 instrumental tracks, printable illustrations and a manual of activities and instructions for each song!
The set provides a fun and less stressful approach to learning to speak with a tracheostomy. The songs allow for the child to explore using their upper airway in a fun and enjoyable way. Songs for Kids with Trachs was developed by a speech-language pathologist, with songs chosen to specifically address the needs of kids with trachs. Many of the songs target difficulty that is common for kids with tracheostomy including improving airflow, improving breath support, vowel production, stops, and nasals.
Each child is different and any speech deficits should be assessed and treated according to individual needs.
Increasing oral exhalation
Therapy can focus on oral exhalation such as blowing, whistles, bubbles, and horns to allow the child to understand how airflow is necessary through the upper airway to produce voicing. Imitation of mouth movements or sounds is also a technique to use. The Animal Face Cut Outs are adorable laminated poster boards that are perfect for imitation. Place your face inside the animal face, say a sound or word and then pass the animal face to the child. It is then the child’s turn to repeat it.
Speech therapy for children with tracheostomy will be similar to those with a natural airway once a speaking valve or cap is in place. Initially there is a focus on exhaling through the upper airway to learn how to use the upper airway for speech. The child may have specific speech sound disorders that are common for children with tracheostomy. A speech-language pathologist can assess the child for which speech sounds are inaccurate in order to treat the child individually.