Acute flaccid myelitis (AFM) is a neurological disorder that affects the anterior horn of the spinal cord, resulting in progressive weakness, loss of motor function, hypotonia and hyporeflexia. Given the progressive and frequently long-term neurological involvement of AFM, patients may require anesthetic care during radiological imaging or other surgical procedures, such as a tracheostomy or the placement of a gastrostomy tube. We present a 4-year-old girl with AFM who required anesthetic care during a tracheostomy. The end-organ involvement of the disease is discussed, pathogenesis and treatment options are reviewed and anesthetic implications are presented.