Ovarian tumors in the pediatric age group, although rare, can be malignant and lethal; the most common is the germ cell tumor. Operation and chemotherapy with multiple drugs is recommended to improve survival. For children with benign ovarian tumors, preservation of ovarian tissue should be a priority. Thirty children with ovarian tumors were treated at Kosair Children's Hospital in Louisville, Kentucky, over the past 19 years. The average patient age was 12 years. Presenting symptoms were acute pain (46%), chronic pain (33%), increased abdominal girth (21%), and a palpable mass (55%). Plain x-ray films of the abdomen, ultrasonography, and intravenous pyelography were helpful in making the diagnosis preoperatively. Emergency laparotomy for an acute abdominal condition was done in ten patients. Twenty-two tumors were benign and eight were malignant. Of the malignant tumors, six (75%) were germ cell tumors, one was a sex cord tumor, and one was a cystadenocarcinoma. Benign tumors were managed by cystectomy or oophorectomy. For malignant tumors, oophorectomy or salpingo-oophorectomy was done initially, followed by chemotherapy and "second look" procedures. Survival ranged from five months to nine years, with an average of 46 months. Four patients died between five and 40 months after diagnosis; the other four have a median survival of 76 months.