BACKGROUND: While children commonly present with acute or chronic upper respiratory tract disorders in general practice, in the majority of cases these problems are seasonal, self limiting and/or unlikely to cause long term disability. However, assessment may be difficult, and on occasions, surgical referral and treatment should be considered. OBJECTIVE: This article provides a general approach in determining when to refer a child to an otolaryngologist. DISCUSSION: Chronic conditions should be considered for surgical management when the pattern of illness in the child is such that significant morbidity is being experienced and this is thought likely to continue for an unacceptable period of time. The need to refer for assessment or treatment of an acute condition is often self evident. In particular, a suppurative complication of a common infection should be considered in an unwell child with upper respiratory tract symptoms.