The acutely ill child requiring intubation is at risk for complications at three crucial points: during the intubation procedure, in the first few hours or days after intubation, and during long-term endotracheal tube (ETT) placement. Consideration must be given to the anatomic and physiologic differences between children and adults that place children at risk for acute respiratory failure and that present difficulties in providing respiratory support. Each potential complication must be understood in terms of cause, assessment, prevention, and intervention. The method of securing the ETT can decrease tube displacement, trauma to the airway, and breakdown of the skin. Intra- and interhospital transport presents more considerations in maintaining ETT placement and physiologic stability of the patient. Prevention of intubation complications in children can reduce length of stay, decrease cost of care, minimize length of time for family separation, decrease potential disabilities and prevent death in the critically ill child who requires intubation.