All patients intubated in the neonatal (NICU) and pediatric (PICU) ICUs over a 3-yr period were evaluated prospectively to determine the incidence of accidental extubation (AE) and contributing factors. Two thousand two hundred patients (age range 26 wk gestation to 18 yr) were intubated for a total of 21,222 days. In the PICU and NICU, a total of 153 patients experienced 195 AE. The PICU had 113 AE in 1,388 subunit for a rate of 1.15 AE/100 intubated days. The NICU had 82 AE in 812 intubated patients, a rate of 0.72 AE/100 intubated days. A review of factors contributing to AE showed the most critical to be: sedation not administered in the 2 h before AE (65%), the lack of two-point or more restraints (58%), and the performance of a patient procedure at the bedside (49%). One death occurred as an indirect consequence of AE. The data are being reported as a function of number of days intubated in an attempt to standardize reporting techniques. The use of standardized reporting and the identification of high-risk factors may be useful for education and modification of patient care practices.