The treatment of chronic pain in children is an enormous challenge. To address this problem, the potential utility of ketamine as analgesic adjuvant is discussed. However, there are yet only very limited data with low evidence that describe ketamine’s analgesic efficacy in pediatric patients. Ketamine’s known unwanted psychoactive and/or medical side effects often seem to be underreported, and their relevance remains unclear. Low, subanesthetic dose of adjuvant ketamine represents an off-label therapeutic option to approach selected children suffering from pain that is refractory to other treatments.