Abstract Background Despite the increased availability of resuscitation courses and guidelines requiring optimal training for acute situations, little is known on the actual qualification of house staff with in-hospital on-call duties for critically ill newborns and children. Objective To assess (1) the characteristics of education and training; (2) the level of experience; and (3) factors that may hamper optimal performance of paediatric specialist registrars caring for acute critically ill newborns and children. Methods A structured questionnaire was completed by a national cohort of all paediatric specialist registrars in their fourth year (ie pre-final) of training. Results Important shortcomings in training and assessment of actual qualifications of resuscitation competencies were identified in paediatric specialist registrars. In 17 of 57 (30%) specialist registrars, competencies in acute care had never been assessed or reconfirmed when starting on-call duties while in the others, 40 (70%), substantial heterogeneity was found regarding the type of assessment of qualifications for on-call duties. In acute situations, occasionally untrained and unsupervised resuscitation procedures were performed. Individual responsibility was the most important stressor that may hamper optimal performance. Despite these findings, adequate reported levels of self-confidence were found; self confidence was higher in newborns as compared to children (7.8 and 7.0 respectively on scale 1–10, p<0.05). Conclusions Successful completion of a resuscitation course does not ensure adequate qualifications by on-call residents, unless regular refresher sessions are provided. Teaching hospitals should establish and implement uniform guidelines for training and assessment of competencies regarding acute care for critically ill children and newborns.