Developmental co-ordination disorder is a motor skill disorder that affects an estimated 5–6% of children but lacks recognition and understanding, leading to under-diagnosis. Essential for diagnosis is a marked impairment in motor co-ordination that significantly impacts daily living, including education. Although ‘clumsiness’ is often dismissed, the impact of this disorder is significant and extends beyond motor skills into physical and psychological health and educational and vocational success. This is discussed here with regard to the framework of the International Classification of Functioning, Disability and Health. This review also discusses the importance of an accurate, early diagnosis and factors that inhibit this; dual diagnosis with comorbid neurodevelopmental disorders; the multidisciplinary approach to diagnosis and the role of the paediatrician within this; and current evidence regarding the most effective interventions.