Background and aims Assessment and management of pain, sedation and drug withdrawal in PICU’s is notoriously difficult. This audit aimed to compare practices across the UK, Ireland (UK&I) and The Netherlands (NL) with regards to pain, sedation and drug withdrawal. Methods An electronic questionnaire was sent to all PICU’s listed in the PICANET database in January 2011 and to all PICU’s in The Netherlands. The questionnaire was sent to the lead nurse, lead doctor, educator or research nurse. Results Response rate: UK&I was 51% (18/35) and for NL 100% (8/8), respectively. 63% of the UK&I centres a pain tool is used but there was wide variation of what tools were used across centres. In contrast, 100% of the NL centres use a pain tool, in 75% the COMFORT Behavioural Scale and Visual Analogue scale or Numeric Rating Scale was used. Assessment tools for the cognitively impaired children were used in 57% of the UK&I centres, however not in NL centres. Sedation tools were used in 66% and 62%, respectively (UK&I and NL) centres. The most common tool is the COMFORT scale. Regarding drug withdrawal, 71% of UK&I centres did not have specific guidelines. However, 50% of the NL centres have specific guidelines and 75% of centres used a withdrawal tool. Conclusions Although there are similarities between UK&I and NL in pain, sedation and withdrawal assessment and management, there is more focus on sedation and withdrawal in the NL compared to that of a stronger pain focus in the UK&I.