To review the safety of early tracheostomy tube change in children.Retrospective case series.Pediatric tertiary care hospital.Twenty-one consecutive pediatric patients undergoing routine tracheotomy.First tracheostomy tube change performed at patient's bedside at 3 (n = 15) or 4 (n = 5) days after surgery.The ability to safely change a tracheostomy tube at the patient's bedside 3 or 4 days after surgery.The first tracheostomy tube change was safely performed at 3 or 4 days after surgery in 20 patients. All changes were accomplished without complication or difficulty on the first attempt. The patients' ages ranged from 4 days to 16 years. The smallest child weighed 1.6 kg. Early tracheostomy tube change was not attempted in one obese 10-year-old girl whose pediatric tracheostomy tube became dislodged and formed a false tract 2 days after surgery.Most pediatric tracheostomy tubes can be safely changed at the patient's bedside approximately 3 days after surgery. Clinical applications of early tracheostomy tube change may include facilitating better hygiene, earlier completion of family caregiver tracheotomy education, and shorter hospital stays. It appears safe and advantageous for surgeons to consider early initial tracheostomy tube change for pediatric patients.