Background. Recurrent respiratory papillomatosis (RRP) is a benign disease caused by Human Papillomavirus (HPV), particularly type 6 and 11. Juvenile onset of recurrent respiratory papillomatosis is a rare case with incidence 1.34 : 100.000 children per year, mean age 3.2 years old. An aggressive complications can occur by spreading into the lower airways or malignant transformation that lead to a lethal outcome.The diagnosis is made based on the history, clinical-radiological findings, histopathological analysis, bronchoscopy and PCR assay examination. The treatment include conventional or laser surgery and several adjuvant therapies. Tracheostomy is common needed to prevent airway obstruction. Quadrivalent HPV vaccine combined with oral acyclovir has been reported in several studies in reducing risk of repeated surgeries and relapses. 
Case Presentation. We reported an 11-years-old girl with diagnosis recurrent respiratory papillomatosis since 2013. She complained voice hoarseness and frequent choking episodes since 2012. She has been through 11 times of mass biopsy extirpation surgeries and histopathological examination with the result papillomatosis. Tracheostomy was performed since the first surgery to maintain airway due to the airway obstruction risk from the papillomatosis. She was examined chest X-ray and CT Scan on 2018 and the result revealed multiple cyst in in both lung segmen lobe. Bronchoscopy was also performed and papilloma was visualized in the right medial lobe of the bronchus. PCR Assay was examined with the result confirmed HPV 11.She commenced Quadrivalent HPV vaccine on 0,2nd, and 6th months combined with oral Acyclovir for 8 weeks. 
Consclusion. It is important to consider a children with voice hoarseness and frequent choking episodes as the part of the papillomatosis symptom. In this patient, diagnose was confirmed by clinical, radiology, bronchoscopy, pathology and PCR examination. Surgery, Quadrivalent HPV vaccine combined with oral acyclovir are the treatment of choice for recurrent respiratory papillomatosis.