Background: Over the past decades, the indications for tracheostomy in children and the routine posttracheostomy course have changed significantly. The purpose of this study was to identify the indications, complications, and outcomes of pediatric tracheostomy. Subjects and Methods: This prospective observational study was conducted involving all children admitted to the pediatric intensive care unit (PICU) requiring tracheostomy from January 2018 to June 2019. A pre-structured proforma was used. The data regarding indications of tracheostomy, complications, and outcomes were analyzed. Patients were followed up till decannulation during the study period. Results: Out of 73 patients included in the study, 68.5% (n = 53) were males and 31.5% (n = 20) were females, with a mean age of 5.4 years. The most common primary indication for tracheostomy was neurological impairment (56.2%, n = 41) and airway obstruction (19.2%, n = 14). The average duration of PICU stay at the time of tracheostomy was 15.4 days. Prolonged mechanical ventilation was required in 62.3% of patients. Elective tracheostomy was done in 84.9% of patients. Complications due to tracheostomy were noted in 43.8% (n = 32) of cases, of which suprastomal granulations were the most common. The average length of PICU stay after tracheostomy was 21.8 days. The rate of successful decannulation was 69.9%. The most common cause for decannulation failure was subglottic stenosis. Conclusions: Neurological impairment requiring prolonged mechanical ventilation was the most common indication for tracheostomy. Suprastomal granulations were the most common complication and subglottic stenosis being the most common cause for decannulation failure.