In a retrospective study, medical records of a randomly selected sample of all infants less than 13 months old with tracheostomy of at least 1 month's duration were reviewed with respect to medical, demographic, and perinatal variables. Standardized outcome measures were used to document physical, cognitive, linguistic, and emotional development in a cross-sectional follow-up of all tracheostomized infants who were without primary mental retardation or neurological and physical handicap. The total sample of tracheostomized infants tended to be white, male, and premature, with moderate to severe medical illness in the perinatal period. There was a high rate of mortality and morbidity, with the majority of survivors presenting with multiple physical and mental handicaps. Follow-up of survivors without other major handicapping conditions suggested that long-term infant tracheostomy may be associated with impaired physical and emotional development, even when cognitive and language development are within normal limits. Pediatricians should be aware of the complex nature of this handicapping condition in order to coordinate appropriate interdisciplinary management.