Haemoptysis is uncommon in children and the diagnosis is challenging. We describe a 14-year-old child who presented with haemoptysis secondary to a suspected congenital broncho-oesophageal fistula. This is a rare condition and the symptoms are insidious, occasionally beginning in childhood but may present only in adulthood. The case report describes the presentation, diagnosis and management of broncho-oesophageal fistulas, with a review of the current literature.