For many paediatric nephrologists, the management of infant with end stage renal disease (ESRD) continues to present not only complicated technical aspects, but very often also an ethical dilemma. When severe neurological or visceral disorders are associated with ESRD, the question of withholding or withdrawing renal replacement therapy (RRT) may be raised early after the delivery. Then, each case has to be considered individually. Options for treatment are palliative, supportive care, or active dialysis and intensive policy of feeding to ensure maximum growth to enable early transplantation. Overnight cycling peritoneal dialysis is the preferred option in young infants and toddlers. The management can be successful only, if there is full cooperation between the experienced and competent team of paediatric nephrologists and other experts and compliance of the patient’s family.

        Key words: end stage renal failure, infants, toddlers, renal replacement therapy, peritoneal dialysis