INTRODUCTION PRO measures aimed at child respondents are generally developed with the input of children from the target population, although in certain cases their age or medical condition can have implications that make this less feasible. This extends also to the translation and linguistic validation of these measures, where the usual standard of pilot testing translations with the target population may not be appropriate or beneficial. This presentation investigates the challenges of pilot testing translations with children, and explores alternative validation methods. BACKGROUND Current guidelines advise that translated PRO measures should be tested with patients from the target population to best assess the measures’ suitability. From our own findings, pilot testing with children can be very successful as they give more creative answers during cognitive interviews, and they can be more willing to give open, honest answers than adults. However, the success of pilot testing with children can vary depending on their age. Younger children may have too limited a vocabulary to express concepts in their own words, or may struggle to understand the cognitive debriefing process. Additionally, in some circumstances there may be ethical issues involved when asking ill children to decide whether to participate in this process which may be difficult for them to understand. ALTERNATIVES Alternative methods must aim to establish the same information that would be obtained from the target population: i.e., whether the translation is appropriate for that group. Therefore we propose review processes involving parents, teachers, paediatric nurses or clinicians, depending on the measure’s content and target age range. CONCLUSION In some cases it is possible to successfully pilot test translated PRO measures with children, and it can be the optimum solution, where practical. However, reviews by parents or suitably qualified professionals are useful alternatives where testing with children might not be feasible.