Venous thrombosis in children remains an uncommon but important entity most commonly seen in hospitalised children. The management of venous thrombosis is a challenge that requires new paradigms in the way we think about research for this disease in children. Recent studies have questioned previous dogma, and the emerging results of the DOAC trials in children create both opportunities and risks. This presentation will discuss the current landscape in the field of VTE treatment in children, providing some practical advice, but also some ongoing food for thought.