BACKGROUND: To assess clinical features and treatment of children’s tracheotomy seen in ENT/Head and Neck Surgery Clinic and Intensive Care Unit at the University Clinical Centre, Prishtina Kosovo. METHOD: A systematic review of the medical records of all patients admitted to the ENT clinic and intensive care unit having tracheotomy between January 2003 and December 2006. RESULTS: During this period, 30 children suffering from respiratory insufficiency underwent surgical treatment. There were 10 (33.33%) female and 20 (66.67%) male patients. The youngest patient was (one week old) and the oldest (18-year old). The single highest number of patients with tracheostomy was in the 15-18-year-old group (40%). Six deaths occurred in this series, but no death was related to tracheotomy. The median hospital stay was 75 days (1 day-1.9 years). Head injury was the commonest cause of respiratory insufficiency, 6 (20%). Only three of them, 10% was with congenital tracheal stenosis. CONCLUSION: Because of possibility of developing life threatening complications, children’s with respiratory insufficiency must followed as soon as possible to the centre that performs tracheotomy, as only treatment option for these patients.