Ten pediatric patients with systemic blastomycosis in Arkansas are reviewed. No particular age predisposition in childhood is apparent and there has been no change in incidence over the previous 40 years. Six of the 10 cases were male and 8 were black. Organ systems most commonly involved were pulmonary, skeletal and skin. With current therapy, usually amphotericin B as a single agent, the case fatality rate is less than 10%. Early recognition and institution of appropriate antifungal treatment remain the most important factors for survival and prevention of chronic pulmonary disease.