The use of uncuffed endotracheal tubes (ETT) in patients younger than 8 years old has been in practice for the last 60 years. In the last decade, there has been a change in clinical practice with a transition to cuffed ETT use, and there continues to be debate between cuffed vs uncuffed ETT use. This narrative review article aims to review the current literature on the topic and highlight some key points in the argument of cuffed vs uncuffed ETT use in pediatric patients. Cuffed ETTs are increasingly being used with several studies over the last 20 years demonstrating its benefits. Studies have claimed cuffed ETT has a clinical, environmental, and economical benefit over uncuffed ETT. Despite shortcomings of various studies and no definitive conclusion of a superior type of endotracheal tube, cuffed ETTs are here to stay in the world of anesthesia.