Discussion Various recruitment and retention strategies were devel- oped for the PEDS-C study. Initial and extra effort strategies were employed to meet the recruitment goal in our large, multi center, complex pharmacotherapy trial in children with CHC. In spite of a high incidence of drug-related adverse events that included flu-like symptoms (88%), gastrointes- tinal symptoms (59%) and headaches (54%), the need for monthly study visits, frequent blood draws (sometimes weekly), and the great distances that some participants needed to travel, study-wide retention rate was remarkably high at 84%. Our recruitment goal was met 6 months after the estimated time of closing enrollment, a fact which further demonstrates the challenges in enrolling and keeping patients in pediatric trials.