Caring for and managing an infant or a child with a chest drain may cause the children’s nurse some anxiety because, although the management is relatively simple, there is potential for disconnection of the equipment, re-accumulation of the pneumothorax and complications – such as pain and infection – that adversely affect the health and wellbeing of the child. Understanding the underlying anatomy and physiology, the pathology behind air leaks, the principles of asepsis, and the assessment and management of a child with a chest drain will enhance the children’s nurse’s confidence and reduce the likelihood of adverse incidents.