Aim: This study aimed to improve nomenclature for accurately describing paediatric tracheomalacia rigid airway endoscopy (RAE) findings and to provide a clinically useful quantitative classification for grading paediatric tracheomalacia severity on RAE. Also, to identify if there are differences between the severity of the narrowing and clinical outcomes. Methods: A three-year retrospective review was undertaken at a tertiary paediatric institution of all cases requiring RAE with documented tracheomalacia findings. Data collected included demographics, tracheomalacia severity/treatment/location, presence of second airway pathology, comorbidities, sleep investigation parameters, swallow assessment and any feeding intervention/s. Statistical tests for significance were performed with the input of a biostatistician. Results: 770 RAEs were performed during the study period (n = 91 children with tracheomalacia with a male preponderance (1.5:1)). The mean age at RAE was 1.3 years. The severity of tracheomalacia was mild in 38%, moderate in 22%, severe in 23% of cases and not documented in 16%. 44% of cases were observed, among which 63% were considered mild. 25% received non-invasive ventilation (NIV) and 30% had surgery +/- NIV. Among those operated, 52% of cases were graded as severe. Chi square analysis identified a difference in the frequency of surgical management among the different categories of tracheomalacia severity on RAE (p<0.0001). There is also a significant difference between the frequency of tracheomalacia treatment between children having a comorbidity versus those without (p=0.0019). The authors identified a consensus for grading tracheomalacia severity on bronchoscopy that may be adopted by ENT surgeons. Conclusion: This paper identified that a finding of severe tracheomalacia on RAE is associated with the probability of escalated management versus mild tracheomalacia. There is also a significant difference between the frequency of treatment where a comorbidity is present.