Biphasic positive airway pressure (BIPAP) (also known as PeV+) is a mode of ventilation with cycling variations between two continuous positive airway pressure levels. In adults this mode of ventilation is effective and is being accepted with a decrease in need for sedatives because of the ability to breathe spontaneously during the entire breathing cycle. We studied the use of BIPAP in infants and children.We randomized 18 patients with respiratory failure for ventilation with either BIPAP (n = 11) or assisted spontaneous breathing (ASB) (n = 7) on Evita 4. Lorazepam and, if necessary, morphine were used as sedatives and adjusted in accordance with the Comfort scale. We compared number of randomized mode failure, duration and complications of ventilation and number and dosages of sedatives administered.No differences in patient characteristics, ventilatory parameters, complications of ventilation or use of sedatives were noted. Ten out of eleven patients that we intended to ventilate with BIPAP were successfully ventilated with BIPAP. Four out of seven patients that we intended to ventilate with ASB could not be ventilated adequately with ASB but were successfully crossed over to BIPAP without the need for further sedatives.BIPAP is an effective, safe and easy to use mode of ventilation in infants and children.