Death from asthma in childhood is rare, occurring in approximately 1 in 10,000 affected children. While most deaths occur in hospitalised children with severe asthma, it has been reported that sudden and unexpected death may occur in children with only mild disease. In this study the clinicopathological features of 11 cases of sudden death taken from the files of the Adelaide Children's Hospital over a 30-year period are reported. Children were aged between 3 years 10 months and 15 years 2 months (average = 9 years 9 months), with a male to female ratio of 5:6. Deaths occurred either at home, in an ambulance or within minutes of arriving in the Emergency Department. Viral respiratory tract infections were common associated findings. While one child was considered to have only mild disease, most children had long histories of asthma and had required prolonged medication or hospitalisation. The demonstration of growth retardation (i.e. height or weight < 3rd percentile) in 73% of cases is also supportive of long-standing severe asthma being present. Thus, in this series, sudden and unexpected death occurred only in children with significant chronic disease. In formulating the diagnosis of sudden death due to asthma in children, delaying growth parameters may, therefore, be an additional useful morphological marker indicating an at-risk child.