The problems involved in the treatment of children aged 5–15 years with chronic renal failure by regular dialysis and transplantation are considered. The problems discussed include access to the circulation, the technique of dialysis, problems of physical growth, bones and sexual maturation together with comments on home dialysis, psychological problems and the results of regular dialysis. Similarly, the technical problems, complications and results of transplantation are considered. It is concluded that results are better than in adults but that the ethical problems related to children leave the ultimate decision as to whether such treatment is in the long term best interests of child and parents as yet unanswered.