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The delivery of radiotherapy to the young child can be a challenging process, particularly where the primary disease is well advanced, involves the central nervous system or requires involuntary immobilisation. Radiotherapy units often sedate children to overcome these problems, which may lead to suboptimal nutrition and sleep disruption. We have reviewed our own practice in preparing young children for radiotherapy and factors influencing use of sedation. Our practice encompasses providing radiotherapy from a paediatric unit, encouraging parents and children to stay until radiotherapy is accepted by the child, structured and unstructured play therapy, and timing radiotherapy to reflect the child's natural sleep pattern.