A special emergency ward for paediatric patients was established at the University Hospital in Nantes on November 7, 1990. Both medical and surgical patients less than 15 years, 3 months of age are admitted. The initial organization of the ward (facilities personnel, on call duty) are described for the emergency paediatric surgery unit. The activity of the unit over a 4 month period (from June to September 1992) was retrospectively examined. During this period, 4,438 children were referred to the emergency ward and 2,905 (64.8%) involved a surgical pathology. The epidemiological characteristics of the patients (age, geographic origin, day and hour of admission), the causal pathology, the examinations and procedures performed, and outcome (length of stay in the ward long-term outcome) were studied. Based on these results, the authors analyzed the factors leading to dysfunction and proposed improvements in the organization of this emergency ward.