In a related editorial, the author comments that “the advent of new treatment options for paediatric immune thrombocytopenia raises questions similar to those faced by physicians that treat adult immune thrombocytopenia. For example, what is the preferred second-line therapy? Single-arm studies suggest that rituximab might induce sustained remissions in more than 20% of children and adults with immune thrombocytopenia, although this might reflect spontaneous immune thrombocytopenia remission. Whether eltrombopag or romiplostim is preferred for children is unknown; while the toxicity profile of the former includes risk of transaminase increases, its oral administration could result in better compliance than weekly subcutaneous romiplostim. We suggest that in children, as in adults, therapeutic decisions should be individualised based on patient needs and preferences.”