The procedure tracheostomy involves making an opening in the airways and introduction of tube into tracheal rings in order to bypass obstruction and allowing air to reach the lungs. The survival of neonates and children witnessed substantial improvement following implementation of such procedure; therefore, the rate of performing tracheostomy in children has become high. Little information is available about complications of tracheostomy in Hilla general teaching hospital. Aim of the study: to

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... ighlight the main indications and complications in association with tracheostomy in pediatric age group in Hilla, Babylon province, Iraq. Patients and methods: The current prospective study included 41 children less than 12 years of age form the pool of patients admitted to intensive care unit at Hilla General Teaching Hospital and the intensive care unit at Babel Pediatric and Maternity Teaching Hospital. The study extended from March 2018 to September 2019. All those children underwent tracheostomy for a variety of reasons. They were followed up for one year for recoding any possible complication in association with tracheostomy procedure. Results: After one year of follow up, the time until decannulation was ranging between 45 to 365 days with a mean of 61.73 days. Upper air way obstruction was seen in 12 cases while assisting ventilation in prolonged intubation was seen in the majority, 30 cases. Causes of upper airway obstruction were Craniofacial anomaly, Subglottic stenosis, Laryngotracheal stenosis, Vocal fold paralysis and Subglottic hemangioma. The reasons for prolonged intubation included Neuromuscular disease, Postoperative period following major surgery, Respiratory failure, Trauma and Subglottic hemangioma. Conclusion: The main indications for tracheostomy in children were congenital upper air way obstruction and the need for prolonged mechanical ventilation and the main complications are either intermediate cannula loss or late subglotic obstruction.