Nonmalignant fibrosing tumors in the pediatric hand or juvenile fibromatoses are uncommon and so may be a challenge to the clinician. We propose a diagnostic and treatment approach to nonmalignant fibrosing tumors of the pediatric hand based on a review of 12 patients who presented with 16 distinct hand lesions. We performed a retrospective 7-year chart review of 12 pediatric patients all with nonmalignant fibrosing conditions of the hand. All patients were operated on by a single surgeon (D.N.) and all samples were reviewed by a single pathologist (E.P.). Twenty-eight surgical procedures were performed on 12 patients. Lesions were classified by location (7 palmar, 9 dorsal) as well as clinicopathologic characteristics. It is imperative to have a broad differential when entertaining the diagnosis of juvenile fibromatosis. Most important, a diagnosis of true cancer must be ruled out. Other mimickers of this process (eg, juvenile rheumatoid arthritis) must also be considered. Most evaluations begin with magnetic resonance imaging and biopsy but a careful history is, as always, a key part of the evaluation. Some lesions may be observed once a diagnosis has been made. When surgical excision is indicated, wide resection is necessary. This may then require flap reconstruction with tendon and joint repair.