This surgery is done to create an opening into the windpipe below the level of the vocal cords. This is either done to bypass an upper obstruction like subglottic stenosis, or to provide a safer, long-term way to ventilate a child. A removable tube is placed into the opening so the child can breathe. This surgery takes about an hour and the child remains in the ICU for at least a week while the opening heals around the tube. First tracheostomy tube change is done at the bedside by the ENT team after the first week.