OBJECTIVE To analyze the role of risk factors associated with moderate or severe airway injuries in children who underwent endotracheal intubation. METHODS Prospective cohort study. METHODS Pediatric intensive care unit. METHODS All patients who required endotracheal intubation during a 25-mo period (October 1999 through October 2001). Exclusion criteria were death before extubation and weight of <1250 g. METHODS Airway endoscopy at extubation and reevaluation for those reintubated. METHODS Relative risks and 95% confidence intervals were calculated in the univariate risk factor analysis (age, sex, organ failure, difficult intubation, tube size, reintubation, tube changes, and duration of intubation). p Values were calculated from the chi-square test with Yates' correction or for trend, and a value of <.05 was considered significant. To define which of the main variables were independently associated with the outcomes of interest, we used logistic stepwise forward modeling. The Mantel-Haenszel method was used for the stratified analysis between the two independently associated variables. RESULTS The study population consisted of 215 patients (61 newborns and 154 children). Moderate lesions occurred in 24.2% of patients, and severe lesions in 10.7% of patients. Risk factors associated with moderate or severe injury in a univariate analysis were age, sex, organ failure, reintubation, tube changes, and longer duration of intubation. According to Mantel-Haenszel stratified analysis results, reintubation and tube changes were the only variables independently associated with the outcomes. CONCLUSIONS We concluded that to prevent morbidity secondary to airway injury, efforts should be directed to avoid reintubation and tube changes in the concerned scenario.