According to the World Health Organization Training Package for the Health Sector (2008), ‘Children are not little adults’ and specialised care must be targeted to pediatric patients in order to optimize outcomes. In a review of Australia and New Zealand Paediatric Intensive Care (ANZPIC) Registry data from 2006 to 2016, approximately 1600 children <16 years old were admitted each year to one of 21 adult ICUs in Australia and New Zealand who voluntarily submit data. This represents at least 17% of all children (<16 years) admitted to an ICU for care. Respiratory etiology of critical illness was the most common reason for admission (48%), followed by neurological diagnoses (15%) and trauma (11%). According to the ANZPIC data, children from 1 month to 5 years old make up 61% of the admitted patients. Of the total 17 686 children admitted to an adult ICU over the 11 year period, 15 727 (89%) were discharged home directly, 330 (2%) died in the adult ICU, and 1625 (9%) were transferred to tertiary PICU for ongoing care. This data suggests that modern Australia and New Zealand adult ICUs provide a significant proportion of Intensive Care therapies to Australasian children. In this session we will discuss some of the key anatomical, physiological and developmental differences of relevance to critical care of the infant and child. In particular, the translation of common intensive care principles will be highlighted to empower well trained adult intensive care physicians to apply their skills and knowledge to critically ill children.