A potential side effect of tracheotomy in the pediatric population is poor speech development. It has been well documented that children with tracheotomies have delays in expressive and receptive language out of proportion to the child's degree of intellectual functioning. While numerous methods of augmentative devices have been proposed, none are ideal for the child with a tracheotomy. Of the choices available, the Passy-Muir valve is best suited for use in the pediatric population. We present a method of selection of patients for Passy-Muir valve placement currently in use at Blythedale Children's Hospital. The criteria employed include measurement of trans-tracheal pressures. This has not previously been presented in the literature, but has been found to be of significant value in determining who will benefit most from Passy-Muir valve placement.