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To describe the indications, surgical timing, length of stay, hospital charges, and discharge disposition of pediatric tracheostomy patients.Retrospective case series.Large urban academic pediatric hospital.Seventy children and adolescents undergoing tracheostomy placement over a 24-month period.None.Hospital database records were used to determine demographics and readmission rates, tabulate charges, and confirm deaths. Indications for tracheostomies included airway obstruction, inadequate airway protection, chronic lung disease, neuromuscular weakness, and central hypoventilation. Surgical timing of the tracheostomy was grouped into three categories: prolonged mechanical ventilation, elective, or emergent. The overall median hospital stay was 46 days (range 14–254) with a median hospital charge of $136,718 (range $36,237–$913,934). The prolonged mechanical ventilation group underwent a tracheostomy after a median of 26 days (mean 37.5 days) on the ventilator. Eighty-one percent of children were discharged home; 63% of children were readmitted within 6 months, with 11% requiring four or more admissions. The six-month mortality rate was 13%; no deaths were related to the tracheostomy.Children with tracheostomies are a heterogeneous population. Children who require tracheostomy for long-term mechanical ventilation have longer hospital stays than children who receive a tracheotomy on an elective or emergent basis. Hospital readmissions should be anticipated in this complex group of patients.