The majority of children undergoing elective surgery can be discharged home on the same day. This has significant benefits for the child, improves productivity and reduces cost. A paediatric day-case service needs an infrastructure based on the guidelines set up by the Department of Health and professional bodies. The anaesthetist plays a vital role in this service and must be trained to use techniques that minimise perioperative pain and postoperative nausea and vomiting. There are clear published guidelines for the process of selecting appropriate patients and cases. In the past, performing tonsillectomies in children with obstructive sleep apnoea (OSA) as a day-case procedure was controversial. With improving surgical and anaesthetic techniques, most of these cases can now be done as day cases. A consensus statement was released in 2018 with recommendations of which patients should be excluded from this group. Good planning by the ward nurses, play therapists, theatre staff, surgeons and anaesthetists is essential to ensure the smooth running of a unit. Anaesthesia techniques require planning and attention to detail. A multimodal to approach to pain relief including local/regional anaesthesia is essential. Knowledge of risk factors and appropriate prevention of postoperative nausea and vomiting (PONV) is also vital. Regular patient satisfaction surveys and audit of quality and safety of care should be conducted using published standards.