The incidence of tracheotomy in infants under one year of age is increasing due to a broadening of indications, greater acceptance of tracheotomy as an adjunct to other therapy and a lower mortality through improvements in surgical technic and in the postoperative care of tracheotomized infants. Tracheotomy for inflammatory lesions is decreasing, but the incidence of tracheotomy for congenital and miscellaneous lesions is increasing. Of 62 infants under one year of age who required tracheotomy, congenital lesions were considered the cause of the respiratory obstruction in 32 cases (15 males and 17 females) and acquired lesions in 30 (21 males and 9 females). In 8 of the 30 infants in the "acquired" group congenital anomalies were indirectly responsible for the tracheotomy, since it was necessitated following extensive surgical procedures performed in an attempt to correct gross anomalies of organs other than those of the respiratory system. There were 17 deaths in the series of 62 cases. Eight occurred in the miscellaneous group, principally those operated on for gross anomalies of other organs, 3 in the group of 17 congenital laryngeal anomalies, 4 in the group of 18 inflammatory lesions and 2 in the group of 8 neoplasms. Tracheotomy is generally looked upon as an emergency life-saving procedure. However, in most cases it can be a planned, careful operation, preceded by the establishment of an airway to avoid cerebral and surgical trauma. The post-tracheotomy period is the critical period during infancy.