OBJECTIVES: To analyze temporal trends in the incidence and surgical management of children with peritonsillar abscesses (PTAs), and to examine whether there has been concurrent changes in hospital charges or length of stay. METHODS: The Kids' Inpatient Database (KID) from 2000 to 2009 was examined for children less than 18 years old with ICD-9-CM diagnostic codes for PTA (475). Survey weighted frequency and regression analyses were performed across the entire study period on variables of interest in order to determine estimates of national incidence, demographics and outcomes. RESULTS: A total of 20,546 weighted cases of PTA were identified during the study period. There was no significant change in the incidence of pediatric PTA across the study period (p=0.63) or in the rate of nonsurgical management (p=0.85). There was a significant increase in the rates of I&D from 26.4% to 33.7% (p<0.001) and a significant decrease in the rate of tonsillectomy from 13.0% to 7.8% (p<0.001). Mean inflation-adjusted charges significantly increased from approximately $8400 in 2000 to $13,300 in 2009 (p<0.001), and average length of stay was 2.15 days with no significant change during the study period (p=0.164). Mean inflation-adjusted charges for patients undergoing tonsillectomy alone were approximately $1800 greater than mean charges for those undergoing I&D alone (p=0.003) and length of stay was also significantly longer for tonsillectomy patients versus I&D patients [I&D 1.99 days versus tonsillectomy 2.23 days (p<0.001)]. CONCLUSIONS: There was no change in the incidence of pediatric PTAs from 2000 to 2009 but there was a change in surgical management, with a significant decrease in the rate of tonsillectomy and significant increase in the rate of incision and drainage procedures. Hospital charges during this period increased nearly 60% despite no change in rates of CT imaging, surgical intervention or length of stay.