Functional endoscopic sinus surgery (FESS) differs in children and adults. The purpose of this article is to highlight the differences by focusing on the anatomical landmarks and diagnostic and surgical peculiarities present in children. We review the indications of FESS in children, partially based on our personal experience, in order to establish a list of relative and absolute indications for the procedure. We also discuss controversies such as the overuse of FESS for chronic sinusitis and the potential postoperative alterations of pneumatization. The paper includes a retrospective study of our results with endoscopic dacryocystorhinostomy (DCR) in 31 children and the endoscopic removal of 11 juvenile angiofibromas. All patients were reviewed in the out patients clinic. Patency of DCR was evaluated by fluorescein dye application to the conjunctiva, endoscopy with a 2.7 mm rigid endoscope or by means of clinical parameters, such as tearing or recurrent dacryocystitis. For patients operated on for a juvenile angiofibroma endoscopy of the nose and MRI every 6 months for the first two years were scheduled. Functional outcome showed good overall results in 90.3% of DCR after primary surgery. The endoscopic approach to juvenile angiofibromas achieved a cure rate of 90.9% after a follow-up of at least 24 months.