The emergence of avian influenza A/H5N1 viruses has driven pandemic preparations to become government priorities across Europe. To date these viruses have remained poorly adapted to humans and the risk of a pandemic based on H5N1 is unquantifiable. However, the risk of a future pandemic is 100%. Preparations are essential and without these many avoidable deaths will occur. Children will be affected at least as much as adults and may play an important role in amplifying transmission. Pharmacological and public health interventions focused on children will save lives through suggested community measures such as pre-emptive closures of schools, and need to be considered carefully, balancing benefits against negative consequences. Child health services will be hugely stressed by any pandemic but also have the potential to save many lives. The challenge will be to deliver core services in the face of major staff illnesses. Detailed local business continuity planning will be essential.