Percutaneous endoscopic gastrostomy (PEG) tube placement is a well-established procedure in adults as well as in pediatric patients who cannot be orally fed. However, potential serious complications may occur. The buried bumper syndrome is a well-recognized long-term complication of PEG. Overgrowth of gastric mucosa over the inner bumper of the tube will cause mechanical failure of formula delivery, rendering the tube useless. However, published experience in children with buried bumper syndrome is very scarce. In the authors' clinic, 76 PEG tubes were placed from 2001 to 2008, and buried bumper syndrome occurred in 1 patient. The authors report on their experience with buried bumper syndrome, an adapted safe endoscopic removal technique, as well as recommendations for prevention of buried bumper syndrome.