{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T09:49:12Z","timestamp":1777888152439,"version":"3.51.4"},"reference-count":41,"publisher":"SAGE Publications","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PRM"],"published-print":{"date-parts":[[2020,11,23]]},"abstract":"<jats:p>The COVID-19 pandemic is exacerbating longstanding challenges facing children with tracheostomies and their families. Myriad ethical concerns arising in the long-term care of children with tracheostomies during the COVID-19 pandemic revolve around inadequate access to care, healthcare resources, and rehabilitation services. Marginalized communities such as those from Black and Hispanic origins face disproportionate chronic illness because of racial and other underlying disparities. In this paper, we describe how these disparities also present challenges to children who are technology-dependent, such as those with tracheostomies and discuss the emerging ethical discourse regarding healthcare and resource access for this population during the pandemic.<\/jats:p>","DOI":"10.3233\/prm-200749","type":"journal-article","created":{"date-parts":[[2020,10,20]],"date-time":"2020-10-20T11:02:34Z","timestamp":1603191754000},"page":"371-376","source":"Crossref","is-referenced-by-count":6,"title":["Disparities and ethical considerations for children with tracheostomies during the COVID-19 pandemic"],"prefix":"10.1177","volume":"13","author":[{"given":"Lulia A.","family":"Kana","sequence":"first","affiliation":[{"name":"University of Michigan Medical School, Ann Arbor, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew G.","family":"Shuman","sequence":"additional","affiliation":[{"name":"University of Michigan Medical School, Ann Arbor, MI, USA"},{"name":"Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA"},{"name":"Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Helman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Krawcke","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Brown","sequence":"additional","affiliation":[{"name":"University of Michigan Medical School, Ann Arbor, MI, USA"},{"name":"Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA"},{"name":"Office for Health Equity and Inclusion, Michigan Medicine, Ann Arbor, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","reference":[{"issue":"1","key":"10.3233\/PRM-200749_ref1","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1097\/01.PCC.0000298641.84257.53","article-title":"Pediatric tracheostomies: a recent experience from one academic center","volume":"9","author":"Graf","year":"2008","journal-title":"Pediatr Crit Care Med."},{"issue":"2","key":"10.3233\/PRM-200749_ref2","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1177\/0194599814531731","article-title":"Indications, Hospital Course, and Complexity of Patients Undergoing Tracheostomy at a Tertiary Care Pediatric Hospital","volume":"151","author":"Liu","year":"2014","journal-title":"Otolaryngol Head Neck Surg."},{"issue":"5s","key":"10.3233\/PRM-200749_ref3","doi-asserted-by":"publisher","first-page":"S93","DOI":"10.1016\/j.anorl.2018.07.007","article-title":"Revealing the needs of children with tracheostomies","volume":"135","author":"Maunsell","year":"2018","journal-title":"Eur Ann Otorhinolaryngol Head Neck Dis."},{"issue":"2","key":"10.3233\/PRM-200749_ref4","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1177\/0194599818803598","article-title":"Incidence, Epidemiology, and Outcomes of Pediatric Tracheostomy in the United States from 2000 to 2012","volume":"160","author":"Muller","year":"2019","journal-title":"Otolaryngol Head Neck Surg."},{"issue":"1","key":"10.3233\/PRM-200749_ref5","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1177\/0194599812460376","article-title":"Clinical consensus statement: tracheostomy care","volume":"148","author":"Mitchell","year":"2013","journal-title":"Otolaryngol Head Neck Surg."},{"issue":"4","key":"10.3233\/PRM-200749_ref6","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1016\/j.pedn.2016.02.002","article-title":"The Transitional Experience of Family Caring for Their Child With a Tracheostomy","volume":"31","author":"Callans","year":"2016","journal-title":"J Pediatr Nurs."},{"key":"10.3233\/PRM-200749_ref7","unstructured":"Thebault R, Tran AB, Williams V. The coronavirus is infecting and killing black Americans at an alarmingly high rate. Washington Post [newspaper on the Internet]. 2020; Apr 7 [cited 2020 May 12]; National: [about 5 p]. Available from: https\/\/www.washingtonpost.com\/nation\/2020\/04\/07\/coronavirus-is-infecting-killing-black-americans-an-alarmingly-high-rate-post-analysis-shows\/?arc404=true."},{"issue":"19","key":"10.3233\/PRM-200749_ref8","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.1001\/jama.2020.6547","article-title":"Failing Another National Stress Test on Health Disparities","volume":"323","author":"Owen","year":"2020","journal-title":"JAMA."},{"issue":"5","key":"10.3233\/PRM-200749_ref9","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/S2213-2600(20)30079-5","article-title":"Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study","volume":"8","author":"Yang","year":"2020","journal-title":"Lancet Respir Med."},{"issue":"9","key":"10.3233\/PRM-200749_ref10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1001\/jamapediatrics.2020.1948","article-title":"Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units","volume":"174","author":"Shekerdemian","year":"2020","journal-title":"JAMA Pediatr."},{"issue":"6","key":"10.3233\/PRM-200749_ref11","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1001\/jamaoto.2020.0780","article-title":"Safety recommendations for evaluation and surgery of the head and neck during the COVID-19 pandemic","volume":"146","author":"Givi","year":"2020","journal-title":"JAMA Otolaryngol Head Neck Surg."},{"issue":"1","key":"10.3233\/PRM-200749_ref13","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1542\/peds.102.1.137","article-title":"A new definition of children with special health care needs","volume":"102","author":"McPherson","year":"1998","journal-title":"Pediatrics."},{"issue":"4","key":"10.3233\/PRM-200749_ref14","first-page":"519","article-title":"Facilitating speech in the patient with a tracheostomy","volume":"50","author":"Hess","year":"2005","journal-title":"Respir Care."},{"key":"10.3233\/PRM-200749_ref15","doi-asserted-by":"crossref","unstructured":"Frampton S, Agrawal S, Guastello S. Guidelines for Family Presence Policies During the COVID-19 Pandemic. JAMA Health Forum [journal on the internet]. 2020 Jul 6 [cited 2020 Jul 15]. Available from: https\/\/jamanetwork.com\/channels\/ health-forum\/fullarticle\/2768108: [Epub ahead of print].","DOI":"10.1001\/jamahealthforum.2020.0807"},{"issue":"5","key":"10.3233\/PRM-200749_ref16","doi-asserted-by":"publisher","first-page":"709","DOI":"10.3201\/eid1405.071301","article-title":"Pandemic influenza planning in the United States from a health disparities perspective","volume":"14","author":"Blumenshine","year":"2008","journal-title":"Emerg Infect Dis."},{"issue":"1","key":"10.3233\/PRM-200749_ref17","doi-asserted-by":"publisher","first-page":"lsaa036","DOI":"10.1093\/jlb\/lsaa036","article-title":"Law, Structural Racism, and the COVID-19 Pandemic","volume":"7","author":"Yearby","year":"2020","journal-title":"J Law Biosci."},{"issue":"7","key":"10.3233\/PRM-200749_ref18","doi-asserted-by":"publisher","first-page":"1706","DOI":"10.1002\/lary.27463","article-title":"Tracheostomy demographics and outcomes among pediatric patients ages 18 years or younger-United States 2012","volume":"129","author":"Sakai","year":"2019","journal-title":"Laryngoscope."},{"issue":"11","key":"10.3233\/PRM-200749_ref19","doi-asserted-by":"publisher","first-page":"2611","DOI":"10.1002\/lary.25972","article-title":"Two-year mortality, complications, and healthcare use in children with Medicaid following tracheostomy","volume":"126","author":"Watters","year":"2016","journal-title":"Laryngoscope."},{"issue":"19","key":"10.3233\/PRM-200749_ref20","doi-asserted-by":"publisher","first-page":"1891","DOI":"10.1001\/jama.2020.6548","article-title":"COVID-19 and African Americans","volume":"323","author":"Yancy","year":"2020","journal-title":"JAMA."},{"issue":"4","key":"10.3233\/PRM-200749_ref21","doi-asserted-by":"publisher","first-page":"1053","DOI":"10.1377\/hlthaff.25.4.1053","article-title":"What does social justice require for the public\u2019s health","volume":"25","author":"Gostin","year":"2006","journal-title":"Public health ethics and policy imperatives. Health Affairs."},{"key":"10.3233\/PRM-200749_ref22","unstructured":"Global Tracheostomy Collaborative [Internet]. [place unknown]: Global Tracheostomy Collaborative; 2020 [updated 2020 May 19; cited 2020 May 24]."},{"key":"10.3233\/PRM-200749_ref23","first-page":"21","article-title":"Tracheostomy 3: care of patients with permanent tracheostomy","volume":"112","author":"Everitt","year":"2016","journal-title":"Nursing Times."},{"issue":"7","key":"10.3233\/PRM-200749_ref24","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1513\/AnnalsATS.201910-780OC","article-title":"\u201cThis Is How Hard It Is\u201d","volume":"17","author":"Amar-Dolan","year":"2020","journal-title":"Family Experience of Hospital-to-Home Transition with a Tracheostomy. Ann Am Thorac Soc."},{"issue":"2","key":"10.3233\/PRM-200749_ref25","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1097\/NHH.0000000000000853","article-title":"The Ventilator-Dependent Child: What Every Home Care Nurse Needs to Know","volume":"38","author":"Estrem","year":"2020","journal-title":"Home Healthc Now."},{"issue":"6","key":"10.3233\/PRM-200749_ref26","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1377\/hlthaff.2018.05531","article-title":"Home Health Care For Children With Medical Complexity: Workforce Gaps, Policy, And Future Directions","volume":"38","author":"Foster","year":"2019","journal-title":"Health Aff (Millwood)."},{"key":"10.3233\/PRM-200749_ref27","unstructured":"Ollstein AM, Kenen J. Disabled, elderly going without home care amid shortage of protective gear and tests. Politico [newspaper on the Internet]. 2020 May 3 [cited 2020 May 12];Health Care:[about 9 p.]. Available from: https\/\/www.politico.com\/news\/2020\/05\/03\/home-care-coronavirus-229723."},{"key":"10.3233\/PRM-200749_ref30","unstructured":"Minder R, Peltier E. Virus Knocks Thousands of Health Workers Out of Action in Europe. New York Times [newspaper on the Internet]. 2020 Mar 24 [cited 2020 May 12]; World: [about 7 p.]. Available from: https\/\/www.nytimes.com\/2020\/03\/24\/world\/europe\/coronavirus-europe-covid-19.html."},{"issue":"3","key":"10.3233\/PRM-200749_ref33","doi-asserted-by":"publisher","first-page":"102490","DOI":"10.1016\/j.amjoto.2020.102490","article-title":"Embracing telemedicine into your otolaryngology practice amid the COVID-19 crisis: An invited commentary","volume":"41","author":"Pollock","year":"2020","journal-title":"Am J Otolaryngol"},{"issue":"3","key":"10.3233\/PRM-200749_ref34","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1080\/13638490400021503","article-title":"Tracheostomy speaking valves for children: tolerance and clinical benefits","volume":"8","author":"Hull","year":"2005","journal-title":"Pediatr Rehabil."},{"issue":"4","key":"10.3233\/PRM-200749_ref35","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1016\/s1056-4993(02)00021-4","article-title":"Education rights and the special needs child","volume":"11","author":"Dalton","year":"2002","journal-title":"Child Adolesc Psychiatr Clin N Am."},{"key":"10.3233\/PRM-200749_ref36","unstructured":"Green J, Gu J. Majority Black Counties See Triple the Covid Death Rate. Bloomberg [newspaper on the Internet]. 2020 May 11 [cited 2020 May 18]; Graphics: [about 3 p.]. Available from: https\/\/www.bloomberg.com\/graphics\/2020-coronavirus-outbreak-us-african-american-death-rate\/."},{"issue":"18","key":"10.3233\/PRM-200749_ref37","doi-asserted-by":"publisher","first-page":"e41","DOI":"10.1056\/NEJMp2006141","article-title":"Critical Supply Shortages\u00a0\u2013 The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic","volume":"382","author":"Ranney","year":"2020","journal-title":"N Engl J Med."},{"key":"10.3233\/PRM-200749_ref38","unstructured":"Bohmer RMJ, Pisano GP, Sadun R, Tsai TC. How Hospitals Can Manage Supply Shortages as Demand Surges. Harvard Business Review [magazine on the internet]. 2020; April 3 [cited 2020 May 12]: [about 12 p.]. Available from: https\/\/hbr.org\/2020\/04\/how-hospitals-can-manage-supply-shortages-as-demand-surges."},{"issue":"8","key":"10.3233\/PRM-200749_ref39","doi-asserted-by":"publisher","first-page":"928","DOI":"10.1513\/AnnalsATS.202004-362VP","article-title":"Preparing for COVID-19 Related Drug Shortages","volume":"17","author":"Shuman","year":"2020","journal-title":"Ann Am Thorac Soc."},{"key":"10.3233\/PRM-200749_ref40","doi-asserted-by":"publisher","first-page":"2049","DOI":"10.1056\/NEJMsb2005114","article-title":"Fair Allocation of Scarce Medical Resources in the Time of Covid-19","volume":"382","author":"Emanuel","year":"2020","journal-title":"N Engl J Med."},{"key":"10.3233\/PRM-200749_ref41","unstructured":"Tobin-Tyler E. In Allocating Scarce Health Care Resources During COVID-19, Don\u2019t Forget Health Justice. Health Affairs [journal on the internet]. 2020 Apr 25 [cited 2020 May 12]; [about 5 p.]. Available from: https\/\/www.healthaffairs.org\/do\/10.1377\/hblog20200422.50144\/full\/."},{"key":"10.3233\/PRM-200749_ref42","unstructured":"Savin K, Guidry-Grimes L. Confronting disability discrimination during the pandemic. The Hastings Center [journal on the internet]. 2020; Apr 2 [cited 2020 May 26]; [about 7 p.]. Available from: https\/\/www.thehastingscenter.org\/confronting-disability-discrimination-during-the-pandemic\/."},{"issue":"8","key":"10.3233\/PRM-200749_ref43","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1016\/s0277-9536(98)00411-0","article-title":"The disability paradox: high quality of life against all odds","volume":"48","author":"Albrecht","year":"1999","journal-title":"Soc Sci Med."},{"key":"10.3233\/PRM-200749_ref44","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1016\/s0196-0644(94)70318-3","article-title":"Quality of life following spinal cord injury: knowledge and attitudes of emergency care providers","volume":"23(4","author":"Gerhart","year":"1994","journal-title":"Ann Emerg Med."},{"key":"10.3233\/PRM-200749_ref45","doi-asserted-by":"publisher","first-page":"1815","DOI":"10.1016\/s0140-6736(09)62050-x","article-title":"Disability and the training of health professionals","volume":"374(9704","author":"Shakespeare","year":"2009","journal-title":"The Lancet."},{"key":"10.3233\/PRM-200749_ref47","unstructured":"Estes C. States Are Being Forced Into Bidding Wars To Get Medical Equipment To Combat Coronavirus. Forbes [magazine on the Internet]. 2020 Mar 28 [cited 2020 May 8]; Healthcare: [about 5 p.]. Available from: https\/\/www.forbes.com\/sites\/claryestes\/2020\/03\/28\/states-have-are-being-forced-into-bidding-wars-to-get-medical-equipment-to-combat-coronavirus\/#555676641cde."}],"container-title":["Journal of Pediatric Rehabilitation Medicine"],"original-title":[],"link":[{"URL":"https:\/\/content.iospress.com\/download?id=10.3233\/PRM-200749","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T04:37:06Z","timestamp":1777610226000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/full\/10.3233\/PRM-200749"}},"subtitle":[],"editor":[{"given":"Matthew","family":"McLaughlin","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Christian","family":"Vercler","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2020,11,23]]},"references-count":41,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3233\/prm-200749","relation":{},"ISSN":["1875-8894","1874-5393"],"issn-type":[{"value":"1875-8894","type":"electronic"},{"value":"1874-5393","type":"print"}],"subject":[],"published":{"date-parts":[[2020,11,23]]}}}