In the last 5 years the use of cuffed tracheal tubes in infants and children has become popular worldwide and is accepted by major medical authorities. The advantages of cuffed tracheal tubes in smaller children - in particular the almost 100% chance to insert the right sized tracheal tube at the first attempt and their reliable sealing characteristics within the trachea - makes tracheal intubation and ventilation considerable easier and safer. This certainly compensates for the higher cost of cuffed compared to uncuffed tracheal tubes. The fear that cuffed tracheal tubes cause increased laryngeal damage in small children could not be confirmed, if adequately designed, cuffed tracheal tubes are correctly used. Conditions for the safe use of cuffed tubes in children are the availability of an adequately designed cuffed tube with a proofed recommendation for tube size selection and cuff pressure monitoring. The following rules must be fulfiled when cuffed tubes in children using are: confirmation of an air leak < 20 cmH2O inspiratory pressure with the cuff not inflated, cuff pressure limitation at 20 cmH2O and the avoidance of negative cuff pressures, resulting in sharp, cutting edges of the cuff membrane within the trachea.