Introduction: Tracheostomy is a surgical procedure to establish direct communication between the trachea and external environment by creating an opening into the anterior wall of the trachea and introducing a cannula into it. While performing pediatric tracheostomy, chances of complication are more especially in newborns and infants. In modern times, the long term outcome of tracheostomy is considered satisfactory due to more specific indications. Aims: Paediatric tracheostomy is a lifesaving procedure to secure airway, practised since ancient days. Paediatric tracheostomy is quite a less studied topic among literature. We took up this clinical study to assess its recent trends in terms of indications, complications, and management of its complications. Material and Methods: This is a prospective, observational study of 3 years duration, which was carried out in a tertiary care hospital of north India with the participation of Otorhinolaryngology, Paediatric and General surgery departments. Results: A total of 39 paediatric tracheostomies were included in this study. The major indications in this study were infective causes like Diphtheria (46%) and Tetanus (16%). The male to female ratio was 1.5: 1 and the rural to urban ratio was 4.5: 1. The most common complications were intraoperative haemorrhage, sudden apnea, secondary haemorrhage and difficult decannulations. The mortality rate in this study is found to be 46%. Conclusions: Upper airway obstruction due to infections like Diphtheria and Tetanus are the most common indications for paediatric tracheostomy in rural areas. Sound knowledge of the anatomy of the pediatric trachea combined with good surgical skills can reduce almost all the major complications associated with tracheostomy in children. Mostly, the higher mortality attributed to paediatric tracheostomy is due to the primary disease condition itself rather than related to complications arising out of tracheostomy procedure.