Tracheotomy in infants is considered to be associated with a high complication rate. This study was conducted to establish the indications and complications associated with tracheotomy in patients less than one year old. The charts of 44 consecutive infants operated on between 1982 and 1991 at the Montreal Children's Hospital were reviewed. The intra-operative complication rate was 9%; the postoperative was 18%. Home care was associated with a very low morbidity. The mortality attributable to tracheotomy was 5%. Significant complications were associated with the lack of availability of the correct size tracheotomy cannula. This study finds a significant rate of complications in the infant age group, but differs from other studies in finding that very premature neonates do not experience a higher rate of complications.