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Another consideration is to monitor for increasing TTP with each exhalation. The manometer provides a reading of pressure at the level of the tracheostomy at the end of the exhalation. A child may exhibit blowing off the PMV or breath holding, which otherwise may be interpreted as clinical intolerance. Children, specifically infants and those under the age of two years or those with developmental delays, are not able to voice on command which would typically be a method used with older children or adults during assessment of upper airway patency. Perspectives on Voice and Voice Disorders, 12 3 , 7. Effects of cuff deflation and one-way tracheostomy valve placement on swallow physiology.

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Iris. Age: 25.
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S Tracheotomy tube occlusion status and swallowing function.

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Viviana. Age: 24.
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Due to the limited volitional participation of infants and young children, the clinical assessment of pediatric use of the PMV presents with specific challenges that are unlike those observed in the adult population. Due to this lack of experience, children may demonstrate various clinical presentations that appear as respiratory difficulties but require behavioral adjustments. Placement of the PMV requires full deflation of the cuff, yet having the added circumference of the deflated cuff material present can reduce airflow and affect the ability to use the Valve. Long term tracheostomy placement has been associated with delayed acquisition of language and social development Cowell, et al. Furthermore, in young children who have had a tracheostomy for the majority of their life, they may not be able to complete a more normalized exhalation process and may not be able to coordinate exhalation with phonation. Measurement of end-expiratory pressure as an indicator of airway patency above the tracheostomy in children. Because of these potential changes, the clinician must continually monitor and evaluate the needs of the child.

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