Increased Neck Visual Fixation in Children With Tracheostomies: An Eye-Tracking Study

The aim of this study is to objectively quantify the attentional distraction effect of a tracheostomy on visual attention and gaze using eye-tracking technology.

This was a cross-sectional observational study. An eye-tracking device was used to capture eye movements of participants over 5 years of age who were shown 20 images of children with and without tracheostomies. The primary outcome was the number and duration of fixations on different mapped regions of the head and neck, including the central triangle (CT) and peripheral triangle (PT) of the face, and the anterior neck. Facial recall recognition was also assessed and compared across groups.

A total of 160 participants were recruited (57% female, median age 18 years, range 6-54 years). The greatest amount of time was spent viewing the CT of both children with and without tracheostomies. Participants viewed the necks of children with tracheotomies 3.7 times more frequently, spent eight times longer viewing the neck, and were more likely to incorrectly recall children with tracheotomies compared with the control group (3.33 vs. 0.85 fixations, p < 0.001; 0.15 vs. 1.12 ms, p < 0.0001; p < 0.001).

Viewers who are looking at children with tracheostomies redirect their attention from the face toward the neck and spend a longer duration of time viewing the necks of children with tracheostomies compared to those without. Viewers are also more likely to incorrectly recall the faces of children with tracheostomies. These findings highlight a possible explanation for why social interactions may be different for children with tracheostomies beyond their underlying medical and communication problems.