This review reports on recent developments in proton magnetic resonance spectroscopy (MRS) and its potential clinical application in pediatric neuroradiology. An overview of the essential principles of the methodology including pulse sequences and their practical application is provided. Each of the major neurochemical compounds found in the pediatric brain and its potential clinical significance is reviewed. Special consideration is given to issues of quantitation and maturational changes in neurochemistry which are unique to the developing brain. Examples of potential clinical applications of proton MRS are given in a brief case report format. Finally, the direction of likely future developments and the need for further investigation of proton MRS in pediatric populations is discussed. This review will provide the reader with a basic foundation for deciding when a proton MRS exam may be helpful for diagnosis and for the interpretation of proton MRS findings in the pediatric neuroradiology setting.