Based on limited information available for cranial nerve palsies in children, the authors aimed to collect data on new onset paediatric sixth nerve palsies in a UK population. This was a retrospective study over 10 years for children aged <18 years; 59 children were identified from case records and nine excluded due to lack of data. The cohort included 19 females and 31 males with average age at presentation of 6.2 years (range 0-16). Five were <1 year at presentation. There were 41 unilateral cases, seven bilateral and two no recorded. Bilateral cases were due to neuro or trauma causes. The highest common causes for non-isolated cases were raised intracranial pressure, tumour, intracranial surgery, viral and infection. Presentation was to eye casualty, main A&E department, general practitioner or seeking second opinion. For isolated cases, common causes were viral or idiopathic. Non-isolated cases were greater than isolated. The authors state a role for imaging in non-isolated cases specifically.