Three short videos of children undergoing tracheal suction

Emma is so young that it has to be her parents and the nurse who cooperate to make the procedure as easy as possible for her. 
As Emma is aware of what is going to happen from the very moment she gets to the consultation room, her parents have learned that the procedure has to be performed as quickly as possible. 
To make the suctioning tube bother Emma as little as possible, her head and arms must be fixed and slightly bent upwards to avoid her pulling the tube. 
It is not very nice, so everything is ready to start the procedure before Emma is fixated. 
It appears violently and she is fighting it. 
Her parents support her splendidly. They are very attentive and immediately after the procedure ready to comfort with toys and her dummy. 
It only takes a few minutes before Emma stops crying and feels better willing to eat raisins. 

Comments/considerations: 

It is a healthy and necessary reaction that Emma is protesting.. It would be more extraordinary if she did not. 
If Emma went happy into the consultation room, you might choose to make the tracheal suctioning at the end of the consultation. 
If Emma only came with one of her parents or if one of her parents would not like to fixate her, it is always possible to call a nurse for assistance. 
With small children it is a good idea to make the tracheal suctioning before breastfeeding or bottle feeding as the procedure may provoke vomiting. 
We use sugar water (1%) as a pain-reliever in babies from 0 to 6 months - and offer e.g. raisins/fruit gum afterwards from the age of 1 year if the parents permit it. 
If the parents do not permit this, we ask them to find or bring something that they know will comfort the child (dummy, soft toy, fruit-bar etc.). 
If the parents would not like to fixate their child, it is our job to talk with them and try to help them. We try to find a space to talk without the presence of the child or we talk on the phone. 
Often it will be “educational” for the parents to try a tracheal suctioning themselves. We have learned, that it will often be a great help both for the parent and the child to see that the parents are ready to try and able to cope. 

From the age of 2 – 4 years, children are able to understand simple explanations about why they need tracheal suction; as soon as you experience the very first sign of this, it is a matter of seizing the opportunity and begin to involve the child in the cooperation. You can start by offering simple options (e.g.do you want to sit with mum or dad today? /Am I going to count to 2 or 3 today? Never expect or ask for too much, but know that the child cooperates as good as possible. Always praise and try to build up confidence; take time afterwards to allow the child to react, talk about it and do something nice. 

For Jonas the most important thing still is to get tracheal suctioning over and done with as quickly as possible as he often loses courage as soon as he gets in to the consultation room. 
He likes to bike in the long corridor outside the room and he has found out this is his best way to cope with the tracheal suctioning is to stay on the bike. He can race into the consultation room, get his mum on the backseat and keep holding really tight on the handlebars instead of being fixated. He concentrates on breathing and visualizing and he needs support to focus to divert his anxiety. 
Before entering the consultation room, he has tested which nostril the nurse is going to use and is asked to plan what he is going to visualise. Jonas’ mum gets on the backseat ready to support and hold his head and hands if necessary. 
The nurse is “talking him through” the procedure with short orders: “Now you get mum on the backseat”, “then hold really tight onto the handlebars, like last time”, “remember to breathe” and so on. 
The procedure is quickly over and done and Jonas can draw a deep breath when “the butterflies in his stomach have disappeared”. 
Immediately after the videotaping he is eating fruit gum and telling stories about his last birthday.

Comments/considerations:

Jonas and his mum have been working hard towards Jonas’ “tracheal suctioning on bike”. 
The video shows how hard Jonas is working on cooperating! 
If he had not managed so well, it would still be very important to praise and encourage him and have a talk about what was working and what we could work on for the next time. 
It is crucial to “catch up” and make sure that the experience is never felt as a failure – even if the child is crying or was not able to cope as expected. 
Some children will sit on their parents’ lap until they are very old – others prefer to lie on the couch with their head on a pillow while the mum/dad caresses their feet. Another child will stand on his scooter and divert his anxiety by concentrating to keep his balance. The challenge is to support and help the child until he/she has found a way to cope. 
   

Johan has already learned how to cope with the tracheal suctioning, so it only crosses his mind the short time it takes to get it over and done with; but it still has to get to be over and done. The sound of suctioning is still a “nasty sound” and the nurse has to count to as little as possible! 
Johan is only 4½ years old, and the video was made to show that one day the child will learn to cope and voluntarily go into the consultation room. 
Tracheal suction is uncomfortable for a few seconds – but Johan no longer feels it is a violation. 
All the times Johan has protested and has been fixated has caused no damage to his mind; on the contrary he is still a strong, lovely boy ready to face the challenges of life. 
Johan tells that he tried to think of how he could do the tracheal suctioning but nothing happened - and then suddenly he could. 
Never lose heart – even though it may be difficult!