The use of autologous blood has been encouraged by blood banks and transfusion services for the past 10 years, mainly because of public concern over the safety of blood. The virtues include reduced likelihood of reactions to transfused blood and reduction or elimination of the risk of alloimmunization and transfusion transmitted diseases such as hepatitis C and the human immunodeficiency virus. The pediatric patient population has been largely excluded from published series on autologous blood usage. In this article, the literature on the use of autologous blood in pediatric patients is reviewed, and some considerations for collecting autologous blood from smaller patients are addressed, including the volume of blood to collect from smaller patients. Based on the experience reported in the literature, patients as young as 6 years of age may be candidates for autologous blood donation before a scheduled surgical procedure. Other methods to provide autologous blood for pediatric patients are discussed, including intraoperative hemodilution and intraoperative and postoperative blood salvage. By considering all the potential options available to pediatric patients, the likelihood of requiring transfusion of allogeneic blood can be reduced, along with the associated risks.