Tracheostomy tube - eating

When you get your tracheostomy tube, or trach, you may be first started on a liquid or very soft diet. Later the trach tube will be changed to a smaller size which will make swallowing easier. In some cases, your health care provider will tell you not to eat right away if there is a concern that your swallowing is impaired. Instead, you will get nutrients through an IV (an intravenous catheter placed in a vein) or a feeding tube. However, this is not common.

Once you have healed from surgery, your provider will tell you when it is safe to advance your diet to take in solids and liquids by mouth. At this time, a speech therapist will also help you learn how to swallow with a trach.

• The speech therapist may perform some tests to look for problems and make sure you can eat safely.
• The therapist will show you how to eat and will be able to help you take your first bites.

Certain factors may make eating or swallowing harder, such as:

• Changes in the structure or anatomy of your airway.
• Not having eaten for a long period of time,
• The condition that made the tracheostomy necessary.

You may not have a taste for food anymore, or your swallowing muscles may not work well together. Ask your provider or therapist about why it is hard for you to swallow.

These tips may help with swallowing problems.

• Keep mealtimes relaxed.
• Sit up as straight as possible when you eat.
• Take small bites, less than 1 teaspoon (5 mL) of food per bite.
• Chew well and swallow your food before taking another bite.

If your tracheostomy tube has a cuff, the speech therapist or provider will ensure the cuff is deflated during meal times. This will make it easier to swallow.

If you have a speaking valve, you may use it while you eat. It will make it easier to swallow.

Suction the tracheostomy tube before eating. This will keep you from coughing while eating, which could make you throw up.

You and your provider must watch for 2 important problems:

• Choking and breathing food particles into your airway (called aspiration) that can lead to a lung infection
• Not getting enough calories and nutrients

Contact your provider if any of the following problems occur:

• Choking and coughing while eating or drinking
• Cough, fever, or shortness of breath
• Food particles found in secretions from the tracheostomy
• Larger amounts of watery or discolored secretions from the tracheostomy
• Losing weight without trying, or poor weight gain
• Lungs sound more congested
• More frequent colds or chest infections
• Swallowing problems are getting worse

Trach - eating

Dobkin BH. Neurological rehabilitation. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 55.

Greenwood JC, Winters ME. Tracheostomy care. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 7.

Mirza N, Goldberg AN, Simonian MA. Swallowing and communication disorders. In: Lanken PN, Manaker S, Kohl BA, Hanson CW, eds. Intensive Care Unit Manual. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 22.

Updated by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.