Tracheostomy on an infant
As a procedure, it was established in the 19th century in Europe because of diphtheria and polio epidemics.In children its frequency is growing, in USA it is calculated in 6.6 procedures/100.000 kids/ year. It is indicated in cases where there is an obstruction of the superior airway, prolonged intubations and in cases of chronic pulmonary aspiration.

Upper airway obstruction
Prolonged mechanical ventilation
Pulmonary toilet in cases of chronic pulmonary aspiration

Preferably always planned, not as an urgent procedure.
Distal tracheal stenosis.

Preferably always planned, not as an urgent procedure. During it, communication between the anesthetist and the surgeon is mandatory.  
For a successful procedure, it is essential to evaluate the indication and the patient, knowing and performing and adequate surgical technique, and to be prepared and treat properly any complication.

Preoperative evaluation includes a full medical exam in which second obstruction sites must be discarded, external neck exam to predict the approach difficulty, cardiorespiratory status that can predict certain complications.

Infant neck extended, thyroid and cricoid cartilages.The larynx is higher in the neck
The cricoid cartilage is the most prominent structure, thyroid cartilage has a broader angle in infants and is partially shielded by the hyoid superiorly. The trachea is soft and has more lateral mobility.

Its necessary to understand the changes in size and orientation during dissection.
knowledge of the different types of tracheostomy tubes and the proper size for each patient is mandatory.

Complications can be immediate: emphysema, pneumothorax, bleeding, selective cannulation, obstruction or decannulation. Late complications are: tracheal stenosis, esophageal puncture, fistula, suprastomal collapse and tracheomalacia.

The authors have no funding or financial relationships or conflict of interest to disclose

Lewis et al. Tracheotomy in pediatric patients: A national perspective. Archives of Otolaryngology Head and Neck Surgery, 2003; 129: 523 – 529.
Campisi, et al. Pediatric Tracheostomy. Seminars in Pediatric Surgery. 2016
Keinman et al. Part 14: Pediatric Advanced Life Support. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010; 122 (suppl 3): S876 – S908.
Kremer et al. Indications, Complications ans Surgical Techniqes for Pediatric Tracheostomies – An Update. Journal of Pediatric Surgery. Nov, 2002; vol 37 (11). 1556 – 1562.
Greenberg, et al. The role of postoperative chest radiography in pediatric tracheotomy. International Journal of Pediatric Otorhinolaryngology. 2001; 60: 41 – 47.
Mitchell et al., Clinical consensus statement: tracheostomy care. Otolaryngology Head and Neck Surgery. 2013;148 (1): 6 – 20.
Lee, et al. The role of polysomnography in tracheostomy decannulation of the paediatric patient. International Journal of Pediatric Otorhinolaryngology. 2016; 83: 132 – 136.
Lippert et al. Care of pediatric tracheostomy in the immediate postoperative period and timing of first tube change. International Journal of Pediatric Otorhinolaryngology. 2014; 78: 2281 – 2285.
Van Buren, et al. Pediatric Tracheostomy: Timinf of the First Tube Change. Annals of Otology, Rhinology & Laryngology. 2015; Vol 124 (5): 374 – 377.
McCormick, et al. Life after Tracheostomy: Patient and Family Perspectives on Teaching, Transitions, and Multidisciplinary Teams. Otolaryngology Head and Neck Surgery. 2015; Vol 153 (6): 914 – 920.