For a long time pediatric tracheotomy has had a poor reputation. Its indications are incontestably restricted in view of improvements in anesthesia and pediatric intensive care. We analysed 144 cases for the period 1976-1986. While very few peri-operative complications were noted, thanks to a rigorous technique, a review of which may be worthwhile, secondary complications such as tube obstruction, accidental displacement and superinfection of the lower airways were often fatal. These could be prevented by better training of both the families and also hospital staff. On average, these children had a tracheostomy for one year. There were few difficulties associated with removal of the tracheostomy tube.