The incidence of epidural spinal cord compression in pediatric malignancies is reported to be about 3%. Early diagnosis is important, since delay in diagnosis may lead to significant morbidity. In this retrospective study, 15 children (8 boys and 7 girls) having epidural spinal cord compression among 551 pediatric patients with malignancies (2.7%) admitted to the Division of Pediatric Oncology, Oncology Institute, between September 1989 and December 1995 have been reviewed. The median age at diagnosis was 6 years (range, 1 month to 14 years). Spinal cord compression occurred in 7 patients with sarcomas, in 2 with non-Hodgkin's lymphomas, in 3 with neuroblastomas, in 2 with germ cell tumors and in 1 with Wilms' tumor. Motor weakness occurred in 87%, sphincter dysfunction in 87%, back pain in 53%, sensory abnormalities in 33%, and extremity pain in 27% of the patients. The median time from onset of symptoms to diagnosis of spinal cord compression was 1 month (range, 3 days to 6 months). Urgent treatment consisted of surgical decompression and laminectomy in 3 patients, radiation therapy in 4, surgical decompression and radiotherapy in 6 and only chemotherapy in 2. Neurologic dysfunction recovered completely in 5 and partially in 6 patients at a median time of 2 months. Early recognition of symptoms and signs of cord compression and immediate therapy are necessary to avoid significant morbidity.