Caring for a child with a tracheostomy in the ward or home environment places additional responsibility on nurses' knowledge and competency to meet the unique needs of the paediatric patient and to fulfil the obligations of education and support to families and carers. This study set out to gain an overview of the care and management of children with tracheostomies through surveying facilities that provided dedicated support to children requiring long-term tracheostomy care in Australia and New Zealand. No recent review of nursing practice and management of the paediatric tracheostomy patient existed. Fifteen units throughout Australia and New Zealand were identified as the sample population. A nurse specialist from each area was asked to comment on their unit practice by completing a survey based on variables identified in the literature regarding tracheostomy care in adult and paediatric populations. Many areas of practice were consistent throughout the units surveyed and, for the most part, practice was based on evidence. Two areas of practice were identified as deviating significantly from the evidence and were therefore highlighted for modification. Those practices were the use of saline instillation as a method of loosening secretions, and the depth to which suction catheters were inserted during tracheal suctioning. These identified areas of concern were highlighted to participating units for modification in practice. Within the research facility immediate changes to practice were implemented, with saline installation being withdrawn from practice standard guidelines. Ongoing quality activities have resulted from these findings.