Hepatitis C affects thousands of children throughout the world. Most children acquire the virus through vertical transmission, although parenteral routes of acquisition are also common. Hepatitis C progresses slowly, with mild biopsy findings and no symptoms in most children and in many adults. However, significant liver inflammation and fibrosis can occur in childhood. Trials of antiviral therapy with interferon and ribavirin have shown these drugs to be effective in almost half of the children treated. Children tend to tolerate therapy well. Further research on the natural history and treatment of hepatitis C in children is needed because the infection can have serious long-term consequences, including end-stage liver disease and hepatocellular carcinoma.