The authors reviewed the records of eight children with renal cell carcinoma and correlated the clinical presentation, pathological and radiologic findings, stage and treatment of the disease with patient survival. Angiography revealed tumours of sparse neovascularity, associated with varied histologic patterns. Patient survival was dependent on the stage of the disease at the time of treatment; treatment of localized disease was effective but of metastatic disease was generally poor. Tumour staging appeared to be the only reliable indicator of prognosis. Children with renal cell carcinoma differ from adults in that a palpable mass in a child does not necessarily indicate that there is metastatic disease.