We retrospectively studied all thirty-five children (M 6, F 29) with sacrococcygeal teratomas admitted to Siriraj Hospital between 1974 and 1999. Although an abdominal delivery is recommended for lesions greater than 5 cm to avoid dystocia, the average diameter of masses which required interventions from dystocia (n = 3) was not different from vaginal delivery (n = 27). All except two first presented with sacral masses recognized at birth. One patient presented with an abdominal mass and the last one was diagnosed after suffering from difficulty in urination. Ninety-seven per cent of cases were completely excised initially (32 sacral, 2 abdomino-sacral approaches), however, six patients required other treatment for recurrent diseases. One mature teratoma recurrence was resected. Two patients who had malignant recurrences following complete benign excisions, died from advanced malignancy. Four presented with malignancy initially. Wound infection, bladder atony and UTI were the most common complications postoperatively. Advanced malignancy was the major cause of death. No patient died directly from the procedure.