Indications, timing, and interventions to the airway resulting in tracheostomy are poorly characterised. There are no promulgated standards of care for tracheostomy in children. This paper addresses the issues associated with decision for tracheostomy, the timing of the intervention, the care for the tracheostomy in both the acute and chronic phase and the necessities for care at home. The paper attempts to describe some of the apparent problems associated with tracheostomy and practical techniques for treatment of the inadvertent complications.