The aim of this international study is to gain information on dexmedetomidine prescription by paediatric anaesthesiologists. We composed an online survey containing questions about the prescription rate of dexmedetomidine, administration route and dosage, adverse drug reactions, education on the drug and overall experience. Members of specialist paediatric anaesthesia societies of Europe (ESPA,n=849), New Zealand and Australia (SPANZA,n=320), Great Britain and Ireland (APAGBI,n=872) and the United States (SPA,n=3130) were e-mailed a link to this survey; responses were collected July and August 2019. Eight hundred and fifty-one invitees (851/5171,17%) responded, of whom 60 did not report their countries and were therefore excluded from the analyses. The ESPA members’ response rate was 25%, SPANZA35%, APAGBI15% and SPA10%. Dexmedetomidine is prescribed by 70% of all respondents (ESPA 121/229,53%;SPANZA 77/111,69%;APAGBI 44/129,34% and SPA 310/322,96%) of whom 73% has access to mostly local protocols. Differences in the use were mainly found in the age of the patients receiving dexmedetomidine (SPA primarily <1 year, others primarily >1 year). Members of SPANZA, APAGBI and SPA had not noted adverse drug reactions, although 61% of ESPA members had noted bradycardia. The majority of SPA respondents were not aware of any contraindications, whereas members from all other societies were aware of these. Although an on-label paediatric indication and clinical evidence have yet been lacking, many anaesthesiologists use dexmedetomidine in paediatrics for premedication, procedural sedation, ICU sedation and anaesthesia. The large intercontinental differences in dexmedetomidine prescription call for consensus and worldwide education on the optimal use of dexmedetomidine in paediatric practice.