Abstract Objetives: Currently, there is scarce evidence about protocols and algorithms for making decisions to support the decannulation process of pediatric patients. The aim of the present study is to make a systematic review of decannulation protocols in pediatric patients that are available in the published literature. Methods: Systematic review of relevant published literature until January 2020 based on studies where a decannulation algorithm or protocol was applied to 1 to 18 year-old pediatric patients who suffered tracheostomy. Main outcomes were Successful decannulation and length of hospital stay. Results: Twenty two studies were included in the review. All the studies were descriptive. Reason for tracheostomy was reported in 76% of the studies most being because of upper airway and facial disorders. Decannulation protocols or algorithms were used in all studies with the exception of one. The successful decannulation rate was over 70% in most studies. Vital signs monitoring as well as partial oxygen saturation were the most used variables in most of cases to decide on decannulation. Conclusion: The lack of proven variabilities which can be used during the decannulation process makes it difficult to provide specific recommendations for decannulation protocols. More level II studies are needed in order to evaluate its effectiveness. There is no consensus amongst the authors regarding the use of the test of occlusion on the tracheostomy cannula, but they agree that polysomnography is a complementary method to fibroscopy which may be related to decannulation success prediction.