Plan for Capping help needed

karma · #1 12-30-2009, 08:24 AM

Hi All,
I had asked this suggestion earlier too.We want to start capping on our 18 month old child.He is good with PMV .Last time we tried capping he would just
not breathe and it turned out he had a scar tissue covering 85% for the airway They removed most of it one month back.
Now how do we start we tried covering his trach with finger but he would not
do well.Ent thought his airways looked good no collapese or issues like that.

DadOf24Weeker · #2 12-30-2009, 11:42 AM

With Sahana, we started by taping over her HME about 50% and gradually increasing as tolerated. It was done with in consultation with her ENT and Pulm. We'd watch her extra closely, especially while sleeping.

Eventually, we got to 100% taped and switched over to a cap one morning when she woke up.

Best wishes,
Harish

Jennifer · #3 12-30-2009, 01:33 PM

It sounds like she is not ready to me. She shouldn't have trouble breathing. We started out slowly with a cap provided by the respiratory therapist at the hospital. My child did fine with PMV & started it at 9 months. He is 3 now. He had tonsils/adnoids out. Reconstructive trach surgery. When we started capping (after all of the above), he did not struggle & did fine. His only problem is he has trouble being capped while sleeping. He is not on a vent anymore. Humidified trach mask while sleeping & capped while awake. Always use a pulse ox to monitor your child until he/she tolerates it well. Be careful.

Jennifer · #4 12-30-2009, 01:38 PM

I also wanted to tell you that our ENT thought my son would be decannulated in 2009. The airway looked good but I told him my child stridored while asleep with cap. We only capped a very short time to see my child's response-stridor. He was puzzled. So no decan----possible in 2010 with use of CPAP machine while sleeping?? Take it one day at a time. Stay positive.

Ainsley's Mom · #5 01-02-2010, 01:56 PM

A child can sometimes tolerate a speaking valve but not a cap because the muscles that open the vocal cords are harder to open for inhalation than it is to force air through the cords during exhalation. So you can't assume that because the air can get out that air can also get in. Hope that makes sense.

I would try distracting him with an activity that he likes, make sure he's wearing his PMV and doing well and then switch to the cap. If he doesn't like the surprise then next time try showing him the cap and telling him you are going to switch it. He may remember having a problem before and just be scared. The main thing is to be ready to do something with him that is fun so he is not solely focused on his breathing. And of course you want to watch carefully to make sure he's going okay. If his airway is able to manage a cap (this can be tough with the cannula taking up space) then he'll eventually get used to the feeling of breathing through the nose and mouth and you won't have to work so hard at it. Good luck!