OBJECTIVES: To identify the annual prevalence of tracheostomized children over an 11-year span in Minnesota. Secondary objectives included decannulation and mortality rates. METHODS: Retrospective review from 2008 to 2018 of a pediatric home care company database that provides home care services for ≥95% of tracheostomized children in Minnesota. The study group was divided into 2 cohorts: tracheostomized children that never required invasive home mechanical ventilation (iHMV) and tracheostomized children that required iHMV. Outcome measures included prevalence rates of tracheostomized children with or without iHMV, primary diagnoses, decannulation, and death rates. RESULTS: Prevalence rates for tracheostomized children ≤16 years of age per 100 000 population increased 39% from 12.3 in 2008 to 17.2 in 2018. This upward trend was primarily associated with an increase in tracheostomized children receiving iHMV. This prevalence trend was inversely correlated with age. There was no significant change in the decannulation rate. The annual all-cause death rate declined over the study period and was primarily associated with decreased mortality in children receiving iHMV. If national prevalence rates in 2018 were comparable to Minnesota, the results suggest there were 2839 pediatric home care patients with tracheostomies not requiring iHMV and 9024 children receiving iHMV. CONCLUSIONS: The population of tracheostomized children in Minnesota is expanding at a disproportionate rate relative to the population of children at large. This increase is predominantly associated with an increase in iHMV. Although the annual all-cause death rate has declined over the past decade, there was no change in the decannulation rate.