Laparotomy for the staging of Hodgkin disease was carried out in 23 patients, ages 2 to 15 years, during a five-year period (1967 to 1972). A standard protocol was developed which included splenectomy, hepatic biopsies, marrow biopsies, and the removal of specimens from five to six designated nodal groups, irrespective of their gross appearance. The clinical stage was altered by laparotomy in 11 of 23 patients, resulting in major changes in management. Eleven children have undergone laparotomies (1968 to 1972) in which no disease was demonstrated. None of these has subsequently developed abdominal Hodgkin disease. The ability of the operator to recognize the presence of Hodgkin disease at surgery was found to be limited. Because of the growth retardation associated with intensive radiotherapy in the child and the unknown consequences of prolonged chemotherapy in this age group, the staging of Hodgkin disease by laparotomy is of unique importance in pediatric patients.