STUDY DESIGN: Two institutional experiences in nonteratomatous sacral tumors of the child were analyzed retrospectively. OBJECTIVES: To examine noncongenital nonteratomatous sacral tumors, which are more common in older infants and, as a group, are rare. SUMMARY OF BACKGROUND DATA: Pediatric sacral tumors usually occur in the newborn period, with most of these tumors being sacrococcygeal teratomas. Other common benign congenital tumors of the sacrum include lipomas, dermoids, and epidermoids. METHODS: Six patients were found in a 6-year period. Four patients underwent posterior resection of their tumors. One underwent a combined anterior and posterior approach. One patient underwent a posterior resection and will undergo a second stage anterior approach later to allow for chemotherapy and radiation to shrink the intrapelvic portion of the tumor. RESULTS: Ages ranged from 8 to 11 years. Three were males, and three were females. Five of six presented with back pain, three had constipation, and two had gait difficulties. Pathologies were diverse. They included ganglioneuroma (n = 1), myxopapillary ependymoma (n = 2), primitive neuroectodermal tumor (n = 1), aneurysmal bone cyst (n = 1), and Ewing's sarcoma (n = 1). No progression of disease has occurred in the follow-up period of 1.5 to 7 years (average, 5 years). Radical resection did not result in instability. CONCLUSIONS: In contradistinction to adults, in whom chordomas and metastases are the most common primary and secondary tumors, the pediatric group does not have a predominant pathology. Tumors may attain extremely large sizes and may be very vascular. Multiple therapeutic methods may be required, including adjuvant chemotherapy and, possibly, embolization. Because of the wide range of pathologies, prognosis is varied.