Aims There is a policy drive for children to contribute more directly in clinic visits. However, this has yet to be routinely achieved in practice and relatively little is known to date about younger children's views of their illness and care. This in-depth qualitative study set out to explore the experiences of children 10 years or younger living with Type 1 diabetes. Methods The sample of 17 children was self-selecting from a population of 140 children under 11 years receiving treatment for Type 1 diabetes at two outpatient clinics in a large, multicultural city. Fieldwork comprised home visits, discussion groups and observation in outpatient clinics. Results Children's strong experiential understandings of their condition, the impact of their social position on experiences of care and their active role in maintenance of the regimen were at odds with how they were positioned, and how the disease was discussed, in clinic. Conclusion Findings have implications for facilitating children's contributions in clinic, understanding how ideas about children are reproduced in clinical settings and supporting clinicians to recognize the capacities and priorities of children living with long-term illness.