Pre-hospital immediate care for seriously injured children is rarely required, but when it is, the response must be prompt and effective. The key to an effective and confident approach to injured children lies in understanding the age related anatomical and physiological differences between adults and children. These differences are most exaggerated in the first few years of life and excellent training courses and materials are available to help practitioners develop their confidence and skills in this age group. An easy to use length based aide memoire and a set of equipment packed according to size are essential to ensure safe management in the pre-hospital environment. Care of the seriously ill child, emergency childbirth and neonatal resuscitation are beyond the scope of this article. Nonetheless, pre-hospital practitioners should develop an understanding of assessment of ill children and normal delivery and be prepared to assist with emergency childbirth and neonatal resuscitation. Excellent educational material, courses and web based resources are available to achieve this (54). This is the sixth article in the add on series in pre-hospital care. The series is edited by Maj R Mackenzie. Maj RC Sutcliffe is a general practitioner and regimental medical officer. Maj R Mackenzie is a Specialist Registrar in Accident and Emergency Medicine and an immediate care doctor. While every effort has been made to ensure correct drug dosages are quoted, readers should always check these before use.