The availability of recombinant human erythropoietin (rhuEPO) has dramatically improved the care of children with chronic renal failure (CRF). Its use provides the opportunity to determine the relative contribution of anemia to the morbidity of CRF. Growth retardation, one of the most significant complications of CRF in children, is the consequence of several inter-related processes, including decreased protein and energy intake, metabolic bone disease, endocrine abnormalities, and anemia. The literature on the use of rhuEPO in children and data from a United States phase III double-blind, placebo-controlled study of rhuEPO in pediatric dialysis patients are reviewed to determine the effect of rhuEPO treatment on the nutritional status and growth of children with CRF. Despite subjective increases in appetite, there were no consistent improvements in dietary intake or anthropometric measures observed during rhuEPO treatment. Children gained weight during rhuEPO treatment; however, this was not generally associated with increased weight standard deviation scores. There was an improvement in growth velocity in some children; however, improvements in height standard deviation scores were infrequently seen. On review of the available literature, correction of anemia with rhuEPO has not been shown to improve the growth of children with CRF.