The case notes of 12 children with congenital H-type tracheo-oesophageal fistulae diagnosed at the Hospital for Sick Children, Great Ormond Street, who presented between 1980 and 1986 were reviewed. All patients presented early in the neonatal period with recurrent chest infections; abnormal chest radiographs were found in eight. Ten of a total of 19 contrast studies were negative. Tube oesophagograms were more likely to demonstrate a fistula than conventional contrast studies. Any delay in surgery was due to delay in diagnosis rather than to delay in presentation. The results suggest that tube oesophagograms should be performed early where there is clinical suspicion of an H-type fistula, and that other investigations (for example bronchoscopy) should be considered if the tube oesophagogram does not demonstrate a fistula.