The indications for tracheostomy have changed over time owing to advancements in treatment and technology. In the early 1980s, many tracheostomies were performed as a result of upper airway infection.1 With the introduction of vaccines against Haemophilus influenza and Corynebacterium diphteriae and improvements in intensive care units (ICUs) in the 1980s and 1990s, the number of tracheostomies required for infectious diseases has decreased.2 Several series have documented the changing indications for tracheostomy in children over the past decade. Also, there are regional differences in tracheostomy indications. In the United Kingdom, three large series 3 5 have reported long-term ventilation as the most common indication for tracheostomies. Research from France,6 Singapore,7 and Spain8 also reports a greater number of tracheostomies being done for ventilator dependency. However, some centers have reported a reversal back to upper airway obstruction as the most common indication, although it is most often owing to acquired or congenital causes rather than infection. Mahadevan and colleagues9 from New Zealand published their experience from 1987 to 2003 and found that upper airway obstruction was the most common indication for tracheostomy. More recent studies from United States,10 Canada,11 and Switzerland12 have also found upper airway obstruction as the most common indication.