Summary In the paediatric patient, small interventions with minimal surgical complexity often require deep sedation or even general anaesthesia. Young children have an elevated risk of complications which can increase dramatically in case of a co-existing disease. The child with an upper respiratory infection challenges the experience of the anaesthesiologist: A thorough assessment of the clinical situation, anticipation, early recognition and skilled treatment of complications, such as stop of breathing and laryngo­spasm, is needed. Care of children with cardiac malformations implicates a pro­‑ found knowledge of the particular car­dio­vascular pathophysiology. The man- ­agement of the diabetic child is optimised by adhering to guidelines and a standardised procedure. Inborn errors of metabolism involving the supply of cellular energy should „set off alarm bells“. Catabolism has to be avoided and a continuous glucose supply will help to bypass a state of life-threatening metabolic dysregulation. The safe anaesthesiological care of sick children requires experience, manual skills and profound knowledge.