When faced with a spontaneous simple pneumothorax, in a previously well child the Archivist would probably leave the smallest of air leaks alone (in a child with no symptoms) and follow-up conservatively. Some sort of intervention is usually advised for the bigger pneumothoraces and written guidelines, often extrapolated from adult evidence, recommend drainage. A large Australian paediatric case series by Robinson et al (http://dx.doi.org/10.1136/archdischild-2014-306696) showed most children had an intervention. Can the adult literature help us? Brown SGA et al (N Engl J Med 2020; 382:405–415 DOI: 10.1056/NEJMoa191077) have published, also from Australia, the results of a randomised controlled …