OBJECTIVE: To review the contribution of new advances in flexible bronchoscopy to the management of respiratory problems in children. METHODS: Over a 10-year-period, 536 flexible bronchoscopies were performed under sedation and local anesthesia in 433 children aged from 5 days to 14 years. Data on symptomatology, underlying diseases, indications, sedation, instrumentation, findings and complications were prospectively collected and stored in a database for later analysis. RESULTS: Underlying disease was found in 300 children (69.3 %). The most common indications for flexible bronchoscopy were persistent atelectasis (n 166), stridor (n 134), tuberculosis (n 66), suspected foreign body (n 61), persistent wheezing (n 55), middle lobe syndrome (n 47) and opportunistic pneumonias (n 41). In 178 patients the procedures were performed on an outpatient basis. One hundred forty-seven bronchoalveolar lavages, 10 bronchial biopsies, and 8 selective bronchographies were performed. Airway anomalies were found in 447 procedures (83.4 %) and 32 pathogenic organisms were identified. In 13 patients cytological study of the samples obtained guided the diagnosis of noninfectious lung disease. Therapeutic interventions were performed in 54 (10.1 %) flexible bronchoscopies. The most important of these were aspiration of bronchial secretions (n 31), removal of foreign bodies (n 6), selective intubation (n 5), and balloon dilatation of bronchial stenosis (n 2). The procedure was diagnostically or therapeutically useful in 391 procedures (79.2 %). CONCLUSION: Although rigid bronchoscopy is currently the procedure of choice in most therapeutic interventions, flexible bronchoscopy is very useful in improving airway exploration and understanding of respiratory disorders in children.