Introduction The challenge of ensuring compliance with a 48-h working week in accordance with the European working time directive has necessitated a fundamental restructuring of medical care. Innovative approaches are needed to ensure that legal requirements are met, while maintaining safety, quality of care, and meeting the training needs of junior doctors.

Aims To evaluate the complimentary strategies employed by a tertiary paediatric unit to meet the challenges of compliance with a 48-h working week.

Conclusion This hospital has initiated several novel solutions to the challenge of reduced working hours, with varying degrees of impact. Paediatric units can benefit from sharing their experiences to help formulate strategies appropriate to the individual trusts.