Introduction Children and adolescents (0–18 years) who depend on long-term respiratory support form an expanding patient group with complex needs that extend beyond medical treatment. Their care often requires collaboration across professional boundaries and should be organised in ways that support both the child’s health and the family’s everyday life. Access to specialised paediatric respiratory care is unevenly distributed, raising questions about how travel distance affects healthcare use and outcomes. This study explored associations between geographical access to specialised services, healthcare utilisation, and mortality, with attention to family and contextual factors relevant for person-centred care. Methods We performed a retrospective, population-based cohort study using data from the Swedish Quality Registry for Respiratory Failure (Swedevox) between 2015 and 2021. Multivariable regression analyses were used to examine the relationship between travel distance to specialised care units, healthcare use, and mortality. Results The study included 600 children (mean age 5.4 ± 5.1 years). Most families (76%) lived within an hour’s travel to a specialised unit, while nearly one quarter had considerably longer travel times. Distance to care was not associated with differences in healthcare utilisation or mortality. However, social and contextual aspects influenced care patterns: children of parents with higher educational attainment had more frequent hospitalisations, and children in rural areas had fewer emergency visits. Conclusions Although physical distance to specialised services was not linked to healthcare utilisation or survival, the findings highlight how family resources and place of residence shape care experiences. From a person-centred perspective, centralisation of specialised services may be justified, but healthcare reforms should be guided by the everyday realities and voices of children and families to ensure that care remains equitable, meaningful and supportive.