RATIONALE: Outpatient treatment of lower respiratory tract infection (LRTI) in tracheostomy dependent children varies institutionally. The objective of this study was to identify whether only increasing airway clearance (AWC) increased the odds of hospitalization within 28 days of treatment. Our hypothesis was that those treated with antibiotics were less likely to be hospitalized. METHODS: We retrospectively reviewed medical charts of children who were tracheostomy dependent between 2012-2019 and followed at our institution. We recorded recommendations with each sick call, i.e. prescription of antibiotics and/or increase in frequency of airway clearance. Generalized estimating equation models were used to determine whether the recommendation to increase AWC frequency was associated with an increased risk of hospitalization within 4 weeks, as compared to the prescription of oral and/or inhaled antibiotics. RESULTS: Of the eighty -two patients reviewed, there were 283 unique episodes of LRTI. 160 (45%) episodes involved increasing AWC alone and 195 (55%) were given an antibiotic in addition to increasing AWC. Of those who received AWC only, 21.7% were hospitalized within 28 days of treatment, and 13.8% were hospitalized after treatment with increased AWC and oral/inhaled antibiotics, p= 0.08. Those who received only AWC did not have significantly higher odds of hospitalization within 28 days of treatment, compared to those who received an antibiotic: adjusted OR 1.47 (95% CI: 0.75, 2.86); p=.26. CONCLUSIONS: In this retrospective cohort study of pediatric patients with tracheostomy, a recommendation to increase airway clearance only versus initiating an antibiotic was not associated with increased odds of hospitalization.