OBJECTIVE To introduce a practical reference for the diagnosis and treatment of space-occupying benign lesions in children's spleens. METHODS Ten cases were collected from 1988 to 2007, and analysis of some related literature were included with special attention to the criteria of the diagnosis and the indications of splenectomy, particularly to the age for operation. RESULTS The age of patients on admission ranged from 5 to 15 years, with the mean age of 10 years. All chose the operation to mitigate the fear of either accidental rupturing or malignancy. The clinical diagnosis depended on ultrasonographic or other imaging findings, while the final diagnosis was based on pathological study of operative specimens. The final diagnosis of the five patients undergoing operation was benign tumors (angioma group), and the other five were cystic (mainly congenital). Eight children underwent primary splenectomy, and the other two underwent partial or secondary splenectomy, all with satisfactory results. Seven were followed up for more than 2 years and recovered uneventfully. CONCLUSIONS Preoperative imaging examinations and postoperative pathology mutually confirmed space-occupying benign lesions in the spleen. The age of the children, size and character of the lesion, as well as the risk of rupturing and malignancy are reasonable indications of surgery. Splenectomy, unless with contra-indications, is a feasible choice of treatment.