The records of 130 children who had had a tracheostomy for more than one month between 1972 and 1982 were reviewed for birth, medical and demographic characteristics, and 32 who were not severely physically or mentally handicapped were followed up at a mean age of 5.5 years. Rates of mortality and morbidity were high, and half of the survivors had moderate to severe intellectual and physical impairments. Even those with the most optimal outcome had significant developmental problems, including slower growth-rate and higher than normal incidences of behavior problems and speech difficulties. Most survivors needed special educational intervention or rehabilitative therapies.