Critically ill children with shock frequently require the administration of inotropic and vasoactive agents. The appropriate choice of inotropic agent in these children forms only part of their overall management. In most cases children requiring inotropes should already have received aggressive fluid resuscitation and prompt tracheal intubation and mechanical ventilation will be indicated in the majority of cases. The first-line inotrope for children with shock and hypotension is dopamine. Dopamine should be administered centrally or via the intraosseous route. In patients resistant to fluid therapy and dopamine secondary agents should be administered; adrenaline for ‘cold shock’ and noradrenaline for ‘warm shock’. Simple clinical and therapeutic endpoints should be used as surrogate markers of cardiac output in order to monitor progress and response to treatment. Children requiring inotropic or vasoactive agents should be reassessed frequently as the cardiovascular profile of children with shock frequently changes particularly during the early phases of their illness.