Cremer and colleagues [65] conducted a multicentre prospective observational study to assess the prevalence of questioning about the appropriateness of initiating or maintaining life support in 15 French-speaking paediatric ICUs, and to evaluate decision-making processes. Among the 5,602 children admitted, 410 died (7%) and 175 of those (43% of the deaths) died after foregoing life support. The utility of life support was questioned in 308 children (6%) with a prevalence of 13 per 100 patientdays. More than 30% of the children survived despite the appropriateness of life support being questioned, and 23% survived despite a decision to forego life support. The median clinician time spent on making and presenting decisions about the utility of life support was considerable at 11 h per child. On any given day in each paediatric ICU, there was more than one child for whom a decision to forego life support was being considered, representing a significant amount of paediatric ICU clinicians' time, and suggesting that this is an important part of paediatric intensive care.