Tracheostomy is indicated for many patients who are in a prolonged comatose state. The procedure in children is believed to be associated with a higher morbidity and mortality; however, most studies have focused on adult patients. Thus, to better define the incidence, a retrospective study was done on 30 head injured pediatric patients who had tracheostomies at our rehabilitation institution. In 26 patients tracheostomy was indicated for prolonged hyperventilation. The average duration of tracheostomy was 49 days. Twenty-six total complications (86.6%) were reported within seven days of tracheostomy; pneumonia was the most common. Twenty-seven late complications (90%) were reported, with tracheal granuloma being the most common. Ten patients (58%) were successfully decannulated during rehabilitation; seven tracheostomies remained patent when patients were discharged. Results of this study confirm the high rate of airway complications in traumatic brain injury pediatric patients and suggest that most occur within 50 days of intubation. Limiting artificial airway management to less than approximately 50 days may markedly reduce airway complications in the pediatric TBI patient.