Paediatricians across many specialities and pharmacists are increasingly being asked to prescribe, or jointly look after, children treated with mammalian target of rapamycin (mTOR) inhibitors (eg, sirolimus and everolimus). There is an expanding list of conditions including tuberous sclerosis and vascular malformations where treatment with mTOR inhibitors may help. This brief practice pointer summarises the practical steps before starting these treatments, what potential side effects to discuss with families and what monitoring arrangements should be put in place.