Discharge against medical advice (DAMA) occurs when a patient leaves a clinical setting before the end of treatment and against medical recommendation. The most important aspects of DAMA are to ensure ongoing medical needs are met and that it is documented meticulously. This article describes a recent retrospective case note (audit) study of DAMA in paediatric patients attending a district general hospital, followed by a literature review. It also discusses the legal implications of DAMA and offers some strategies for clinical practice.