The use of methadone analgesia is undergoing a revival in the field of pain management with doctors, nurses, and other healthcare professionals realising its potential advantages over other commonly used opioid analgesics.1-3 The efficacy of methadone analgesia is well documented in adults, but limited information is available about the use of methadone in younger patients, particularly neonates. Painful experiences in neonates range from all newborns receiving routine vitamin K injections at birth to the critically ill preterm neonates who may experience up to 488 painful procedures during their stay in neonatal intensive care units.4 ,5 The idea that neonates do not experience pain has long been refuted, and doctors are now more likely to administer routine pain relief.6The provision of adequate analgesia and sedation has been proved to maintain physiological stability and improve clinical outcomes in these patients.7 Neonates undergoing surgery often need to be intubated and ventilated for prolonged periods after the operation. Most neonatal intensive care units use opioids such as fentanyl or morphine for sedation/analgesia for these and other critically ill infants requiring ventilatory support.8 ,9 In this article, we report clinical problems associated with the routine use of these drugs and propose the potential benefits of using methadone as an alternative analgesic.