The newcomer to this important topic would be forgiven for finding the lack of research evidence difficult to believe. Children with NMDs are very complex management problems and they consume a lot of hospital resources. The mechanical devices paid for by insurance companies, or governments, cost many thousands of dollars each - surely all this money and time should be based on some form of evidence? Unfortunately this is not the case. Two large reviews of the management of NMDs by both the British(2) and the American(22) thoracic societies emphasized this lack of evidence. Both concluded that the major requirement in the management of these children is research.