Chevalier Jackson, the father figure of bronchoscopy, once famously remarked that if doubt existed whether a bronchoscopy should be performed, then a bronchoscopy ought to be performed. Had he the opportunity to perform fiberoptic bronchoscopy in pediatric and neonatal ICUs, he may well have sung a different song. The performance of a bronchoscopy is deceptively easy: the patient is intubated, there is no upper airway to traverse, no esophagus lying in wait for the inexperienced to enter by mistake, coughing or agitation (except in the bronchoscopist) is unlikely to be an issue; but in no other context is there the need to carefully weigh risk vs benefit. These children are by definition critically ill and may be easy to destabilize. They may be at risk of pulmonary hypertensive crises, systemic hypotension, and intracranial hemorrhage, any of which may be adversely impacted by blocking part of the endotracheal tube with a solid telescope.1 There are benefits for sure,2,3 but in one series,2 10% of children desaturated by ≥ 20%, and 17% required a fluid bolus for resuscitation as a result of bronchoscopy in ICU. Depending on the patient group, important diagnoses were made in 44 to 90% of the patients.