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A tracheostomy is a surgical procedure in which an artificial airway is created in the trachea in order to bypass the nose, mouth and upper airway. There are many indications as to why one is required in children. The care and decisions made around paediatric tracheostomies are complex and necessitate input from several members of the multidisciplinary team. This short personal practice article discusses our approach, surgical technique and overall care when managing a child who required a tracheostomy for ventilatory purposes. We present this in the format of a patient timeline which offers narrative guidance to health care professionals who might be involved with caring for children with tracheostomies. [ABSTRACT FROM AUTHOR]

Stridor is an uncommon yet potentially serious symptom in neonates. It is indicative of airway obstruction. This short article describes how to approach a baby with stridor. Assessment and investigation should proceed in a structured manner. Important clues about the likely cause can be determined using a combination of a careful history and clinical examination. The character and nature of any stridor, combined with information about the onset of symptoms are particularly important. These may help to determine the best initial investigations, including direct visualization of the airway and management. There are different types of airway endoscopy, ranging from awake flexible laryngoscopy that examines to the level of the vocal cords, to rigid laryngotracheobronchoscopy under general anaesthesia that allows additional examination of the subglottis, trachea and main bronchi, and to flexible bronchoscopy that assesses the respiratory tract further still and is particularly useful in assessment of tracheomalacia. A cross-speciality approach is often required to secure the best outcomes. This article is aimed at the whole team who will be involved in dealing with babies with stridor, including anaesthetists, paediatricians, advanced care practitioners and ENT doctors. [ABSTRACT FROM AUTHOR]

Adenotonsillar disorders are a frequent complaint in children and adenotonsillectomy is one of the commonest surgical procedures. The two main indications for adenotonsillectomy are recurrent tonsillitis and obstructive sleep apnoea (OSA). Both are associated with significant morbidity. How best to diagnose OSA is currently unclear. Some centres routinely use sleep studies whilst others rely on history alone. Intracapsular subtotal tonsillectomy, as opposed to complete tonsillectomy, is a good choice in OSA. It is as effective in relieving obstruction but typically has lower morbidity with less pain and bleeding. Postoperative complications are relatively common, and good pain management is essential. There is controversy about effectiveness of tonsil and adenoid surgery, with on-going arguments for and against. Appropriate patient selection based on clinical need and evidence, rather than rationing, is essential. [ABSTRACT FROM AUTHOR]

Both Treacher-Collins (TCS) and Down syndrome cause structural and functional airway abnormalities. We present the case of a neonate with both syndromes who required tracheostomy in the first hour of life due to severe upper airway obstruction. The co-occurrence of both syndromes is rare, and presents unique challenges in securing the airway in the perinatal period. [ABSTRACT FROM AUTHOR]