Thrombolytic therapy is being increasingly used to treat various cardiac and other disorders in the pediatric population. The use of thrombolytic therapy in thrombosis following cardiac catheterization, aortic thrombosis, right atrial and caval thrombosis, pulmonary embolism, thrombosed prosthetic valves, thrombosed Blalock-Taussig shunts, and other disorders is delineated. Special issues of the newborn are discussed. A wider appreciation of the indications and contemporary experience would help in optimizing the use of thrombolytic therapy in children.