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Robust clinical evidence for the use of vasopressin in children is scant. Low dose vasopressin infusions may be tried in catecholamine resistant shock or refractory cardiac arrest. It significantly improves hemodynamic indices without necessarily translating into clinical benefit. There appears to be a trend to greater tissue ischemia with its use. Evidence to date has not demonstrated clear efficacy for vasopressin’s routine use in management of pediatric shock. Further high-quality research is essential before it can be recommended as a routine standard of care.