The importance of evidence based medicine in children has received increasing attention after a history of neglecting children as part of drug development. Drug development present a complex dilemma where the need to gather evidence is balanced with the ethical considerations associated with the burden of conducting clinical trials in children. Paediatric extrapolation is an approach where clinical data in children is partially or fully generated by extrapolating data from relevant sources in adults. In many ways the technical framework for paediatric extrapolation is well established in the field of pharmacometrics and methods are generally encouraged by regulatory authorities. Thus, the use of paediatric extrapolation represents a paradigm shift from traditional drug development in children. But is paediatric extrapolation currently being used optimally? Has the paediatric extrapolation paradigm shift really started? And what is blocking the road for better drug development in children? These are questions we will discuss at this PopSim meeting with an exciting line of presenters and panellists from regulatory authorities and industry.