Compared with the adult population, hepatitis C virus infection may differ in the pediatric age group with respect to transmission, course, and response to treatment. The prevalence of hepatitis C in children is between 0.05% and 0.4%. The major mode of acquisition has shifted from parenteral transmission to maternal-infant transmission. However, the actual rate of maternal-infant transmission is low. The natural history of hepatitis C in children is not well characterized, although the available information suggests a milder disease than in adults. In the eight studies of treatment with interferon for hepatitis C in children, the incidence of a complete sustained response varied from 0 to 45%. No pediatric studies have evaluated quality of life or the effect of treatment on the development of cirrhosis and hepatocellular carcinoma. Children may respond better to treatment than adults. We recommend that children with hepatitis C are considered for treatment only as part of a controlled clinical trial.