Advances in anesthesia and instrumentation miniaturization of endoscopes and high quality fibreoptic systems now allow safe, detailed and precise endoscopic examination of the upper and lower respiratory tract in neonates as well as older children. When the clinical features and radiographic changes suggest a congenital abnormality of the tracheobronchial tree endoscopic examination can give useful information. We believe congenital anomalies of the trachea, particularly areas of congenital stenosis, are not as uncommon as has been supposed. It is now a practical reality to carefully evalute and photographically document tracheal conditions such as vascular or other extrinsic compression, congenital stenosis or web, tracheoesophageal fistula and its sequelae, tracheomalacia and others.