Short-acting nifedipine has been abandoned as a treatment for severe hypertension in adults as a result of significant adverse effects. Despite this, it remains a popular choice for the treatment of severe hypertension in children. However, recent publications describing adverse effects of short-acting nifedipine in children similar to those reported in adults, have prompted some experts to question the continued use of this agent in children. In this review, available data on the pharmacology, clinical efficacy and safety of short-acting nifedipine are reviewed, and the advisability of using short-acting nifedipine is reassessed. Although low (< 0.25 mg/kg) doses of short-acting nifedipine may be safe in some hypertensive children, alternative agents that produce more controlled reductions in blood pressure, and that are easier to accurately dose and administer, should probably be chosen for the majority of children with severe hypertension.