Aim The role of pre‐operative anaesthetic clinics (POAC) in adult practice is well‐established and is developing in paediatric hospitals in the UK. Methods We carried out a retrospective survey of all patients assessed in our POAC by a consultant, determining the pre‐operative problems and the perioperative anaesthetic interventions and outcomes. Results In 2016, 537 patients were seen by a consultant: the median age was 5.5 years (interquartile range 2.2–10.2) and median weight was 18.7 kg (interquartile range 12–28.7). 77% were ASA3 and 4% were ASA4. Seventy‐five percent of patients referred for consultant assessment had a problem with at least one of the following four major body systems: cardiac (37%), respiratory (26%), airway (18%) and neurodevelopment (14%), Fifteen percent of these patients had two of these systems affected, and 3% had three or more. The rate of cancellation due to significant risk was 2.6% (n = 14): nine had significant cardiac risk and five had respiratory reasons. The rate of serious perioperative problems was 2.8% (n = 15): six were cardiac, six were respiratory, two neurological and one coagulation. Cardiac and airway problems occurred during anaesthesia, whereas problems relating to respiratory and neurological disease were post‐operative. Of the 15 patients with three or more body system problems, 5 were cancelled or had a perioperative complication causing deterioration, 5 had a major complication but recovered fully and 5 proceeded to general anaesthesia (GA) without serious event. There were no deaths during GA or within 30 days. Conclusion In the POAC, consultants identified a wide range of GA‐related potential problems enabling patients to be investigated, informed and prepared (or cancelled because of excess risk), and for appropriate resources to be allocated to achieve efficient and safe perioperative care.