Background: Advances in neonatal and pediatric intensive care have increased the number of children who survive with disabilities. The management of the tracheostomized child is a complex and demanding assignment as they have higher rates of complications. Ideally, the decannulation process should proceed once the child no longer requires mechanical ventilation and the underlying pathology has resolved or been reversed. This study highlights our experience in managing pediatric tracheostomy decannulation at a tertiary care center. Subjects and Methods: This was a single-center, prospective study conducted at the tertiary care pediatric hospital for a period of 1 year. Children with tracheostomy in situ who got admitted for laryngotracheobronchoscopy and decannulation were included. Results: Indication of tracheostomy was broadly divided into reasons causing upper airway obstruction and those requiring prolonged intubation. It showed that 82% were due to prolonged intubation, in which 85.3% were due to neurological reasons. The success rate for decannulation was 97%. Age of child, duration of intubation, posttracheostomy period, and type of tracheostomy tube had no significant correlation with outcome of tracheostomy decannulation. Conclusions: Resolution of primary indication for tracheostomy is required before planning of tracheotomy decannulation. Bronchoscopic airway evaluation and decannulation trial in operation theater is needed for successful decannulation. There was no impact of age, duration of intubation, posttracheostomy period, and type of tracheostomy tube on the outcome of tracheostomy decannulation.