BACKGROUND Epidermal nerve fiber (ENF) density, morphology, and epidermal innervation patterns were examined in children using 2 different techniques, punch biopsy and suction blister. METHODS Healthy children without symptoms or history of peripheral neuropathy and normal by neurologic examination were studied. Punch biopsy and suction blister specimens were collected from the lateral thigh and distal leg. ENFs were traced from confocal images of immunohistochemically stained samples. Statistical methods included repeated-measures analysis of covariance. RESULTS Blister and biopsy nerve counts were associated. ENF density in children was dense, lower for older children (P<0.01) and with no difference between boys and girls (P=0.92). Many ENFs appeared multibranched and elongated. CONCLUSIONS Epidermal innervation in the pediatric population is dense and age-dependent. Blister specimens are less invasive and may provide an alternative to punch biopsy for determining ENF density in children at risk for neuropathy.