There are hardly any controlled studies in paediatric tracheostomy care; instead, most established standards, procedures and details have been elaborated at the bedside by trial and error. Once the appropriate tube is chosen, tube care consists of tube change, fixation, management of secretions, humidification of inspired air and application of medications. The stoma requires cleaning, protection and dressing. Child care may be structured into monitoring, feeding, bathing and clothing. Preparing the home and family environment are important prerequisites for discharge from the hospital. Last but not least, the family of the child or other caregivers must undergo a structured and detailed training programme to become competent in long-term home care.