The development of advanced neonatal care and anesthesia techniques enabled patients to be intubated for prolonged periods leading to a rise in incidence of acquired subglottic stenosis and the survival of patients with ventilator-dependent respiratory failure. The decision for tracheotomy tube placement should entail a detailed thought process and individualized plan for each patient. When evaluating children for tracheotomy tube placement, it is important to communicate openly with anesthesia staff. Correct size and positioning of the tracheotomy tube can be confirmed with a post-operative chest radiograph and/or passage of a small pediatric flexible endoscope. After tracheotomy, the patient should be closely monitored in the intensive care unit for 5-7 days. Careful dissection and ligature techniques are used for anterior jugular veins and the thyroid isthmus to avoid complications. Patients with tracheotomies have been shown to exhibit difficulties with speech and language development, even after decannulation.