Background: Red blood cell transfusions are frequently used in the paediatric intensive care unit (PICU) with a primary goal of increasing oxygen delivery to the tissues. There are several disorders in which a high haemoglobin level is suggested to improve outcome, including sepsis and cardiac disease. Nevertheless, red blood cell transfusions are associated with a higher morbidity and mortality rate in critically ill children and adults. In our article, we will give a narrative review of the existing literature on a restrictive transfusion policy in the PICU. Methods: A literature search was done using the terms "red blood cell transfusion" or "erythrocyte transfusion" and "pediatrics" or "child" in the Cochrane, Sumsearch, Trip and PubMed medical databases.Review of literature: Te TRIPICU study offers the largest number of patients in whom a restrictive transfusion policy was concluded to be as safe and efective as a liberal transfusion policy. Several sub-studies were extracted from the TRIPICU database, focusing on specific groups of patients, e.g. sepsis patients, patients with non-cyanotic heart disease who underwent cardiac surgery and patients who underwent general surgery. One additional study focused on cyanotic heart disease, using higher haemoglobin levels than the studies named before. In all sub-categories a restrictive transfusion policy was found to be safe and effective. Conclusion: We conclude that it is safe to work with a haemoglobin threshold of 4.3 mmol/l for children admitted to the PICU with burns, sepsis or after general and cardiac surgery, and 5.6 mmol/l for patients with cyanotic heart disease.