Extracorporeal shock wave lithotripsy (ESWL) has been proved to be an effective method of treating upper urinary tract calculi. However, there is little experience with the use of this approach in pediatric urolithiasis, especially for lower urinary tract calculi. Nine children, aged 1-18 years, were treated here with urolithiasis in the renal pelvis, lower ureter and bladder, using Dornier MFL 5000. A polystyrene plate was used to protect small children from chest damage. Prone position was routinely used to treat lower ureteral and vesical calculi, thus avoiding bony pelvis blockage of shock wave energy. Excellent pulverization was achieved in eight cases; fragmentation in only one case, then required cystolithotripsy for bladder stone fragments three months after ESWL. No patient had melena. Neither hemoptysis nor gastrointestinal complications were seen. Extracorporeal shock wave lithotripsy is a safe and effective method of treating urinary tract calculi in children.