Objective: To identify the age at which spontaneous improvement in vocal fold function occurs that will allow decannulation to be performed in tracheostomy-dependent children with isolated idiopathic congenital bilateral vocal fold paralysis (BVFP). Study Design And Setting: Retrospective chart review in tertiary pediatric center. Results: Three children were identified who underwent tracheostomy between 13 and 45 days old. Two patients have been decannulated at age 5 years 11 months and 7 years 1 month, but both have persistent symptoms of upper airway obstruction. One patient remains tracheostomy-dependent at 4 years of age with only minimal vocal cord abduction. Conclusions: Spontaneous improvement in vocal fold function sufficient to allow decannulation appears to occur during the second quinquennium of life. Significance: Conservative treatment could be considered as an alternative to surgery in severe idiopathic congenital BVFP.