Anaesthesia for ENT surgery in children is varied, interesting and challenging. It ranges from grommet insertion and adenotonsillectomy, some of the most commonly conducted procedures in children, to the rare and evolving fields of airway reconstruction and EXIT procedures. Excellent teamwork and situational awareness are crucial to be safe and effective. This is particularly important in airway surgery given the small size of the paediatric airway, which is shared and often crowded with instruments, the sensitive physiology of small children and their frequent and complex comorbidities. Multidisciplinary team meetings and shared decision-making is increasingly important for these complex procedures and also on occasion for commonly conducted ENT procedures where there is a paucity of data around central issues such as postoperative admission criteria in children with obstructed sleep apnoea (OSA) and analgesia after tonsillectomy. Ultimately agreed local guidance should be followed as further investigations continue. An area of particular interest is the development of more effective modes of oxygenation such as high-flow oxygen delivery.