Proper management of pediatric thyroid nodules is crucial to achieving good outcomes. It is important to obtain a thorough history, including prior radiation exposure and family history of thyroid cancer and any symptoms of hypothyroidism or hyperthyroidism. A complete physical examination with special attention to the thyroid gland and any cervical lymphadenopathy is important. Nodules between 5 and 10 mm with risk factors (clinical or sonographic) and all nodules greater than 10 mm should undergo a fine-needle aspiration biopsy. A comprehensive center of pediatric specialists is the best environment for treatment of these patients.