Fine needle aspiration can serve as the initial diagnostic modality for a wide variety of lesions within the pediatric age group. The utility of the technique depends on the clinical setting and histologic type of tumor under study. FNA is most valuable for staging and conformation of metastatic spread in small round cell malignancies. The use of aspiration cytology as the initial diagnostic procedure for these neoplasms is more controversial since this technique may deprive the clinician of valuable information (histologic subtype, oncogene status) now available only by examination of large tissue biopsies. Similarly, FNA can serve as a triage technique for the separation of patients harboring thyroid nodules or enlarged lymph nodes into operative candidates and non-operative candidates. As cytopathologists become more familiar with the appearance of pediatric neoplasms, this diagnostic technique will become more widely used, reducing the need for operative intervention in the diagnosis of many benign and reactive lesions.