Between July 2023 and June 2024, there were 540 publications from randomised controlled trials (RCTs) in child and adolescent health in low- and middle-income countries (LMICs), identified using a standardised process that has been in use for 21 years. This year, trials addressed a wide range of diseases and conditions impacting the health, development and well-being of children, newborns, adolescents and mothers. The RCTs reflected old, new and neglected problems, the rapidly changing epidemiology and the evolving social and economic circumstances in many countries. They also highlighted local and global priorities in LMICs, as well as environmental factors contributing to poor child health and inequities. The trials tested new and refined treatments, diagnostics, vaccines, holistic management and prevention approaches, and explored many outcomes, including mortality, nutrition, psychosocial measures and development. The studies were conducted in hospitals and primary healthcare clinics, schools and communities. Some studies are of the highest quality, while others fall short. The implications are many, including the need for greater capacity for discriminating synthesis and translation of evidence at a national and local level in many LMICs. This involves resourcing and educational components, with implications for healthcare worker training in research translation, quality improvement and learning health systems. Paediatricians and child health nurses everywhere have a role to play.