As paediatric flexible bronchoscopy has become more prevalent over the past 3 decades, procedures in which the primary aim is beyond visual inspection have similarly become more common. Interventional bronchoscopy procedures are performed less frequently in the paediatric compared to the adult population due to the relative lack of airway tumours as well as limitations of the size of the instrumentation in the former. However, the ability to perform these special procedures when indicated is nonetheless an important part of the armamentarium of the paediatric flexible bronchoscopist. Predominant among these procedures are endobronchial (EBB) and transbronchial biopsy (TBB), although segmental bronchography, assessment and therapy of airway bleeding, drug concentration measurement, assisted intubation and therapy of bronchitis obliterans have also been performed. This chapter reviews each of these indications, focusing in particular on the clinical, research and technical aspects of EBB and TBB. EBB in the paediatric population remains predominantly a research procedure, as evidence to support its use in clinical contexts is lacking. In contrast, TBB has an established role in clinical care, particularly following lung transplantation.