Eighteen patients less than 15 years of age (range, 1.5 to 15 years) were followed prospectively after undergoing splenectomy for blunt trauma. Follow-up time ranged from 1 to 12 years with a mean of 5.8 years. During the follow-up period significant septic episodes developed in two of the 18 (11.0%) patients. During the same period 16 patients less than 15 years of age (range 2 to 15 years) who underwent splenorrhaphy were followed. In none of the patients in the splenorrhaphy group has sepsis developed to date (P = .11). Follow-up studies in both groups included a CBC, peripheral smear, platelets counts, history of infections, and radionuclide scans in the patients undergoing splenorrhaphy. The two patients with significant sepsis were an 18-month-old male with pneumococcal septicemia and a 13-year-old with meningococcal meningitis. Both patients survived these episodes. Although the numbers are small, this prospective study reemphasizes the increased risk of sepsis in the asplenic pediatric patient and the need for close surveillance, parental education, appropriate immunizations, and vigorous treatment of infections. The methods used in this prospective study of patients from one institution could be expanded to a multi-institutional study to obtain prospective data concerning the natural history of pediatric patients undergoing splenectomy because of trauma.