Abstract Forty children with a suspected thyroglossal cyst were operated on by one paediatric surgeon receiving primary and secondary referrals in an 8-year period. Nine patients (22 per cent) proved to have other pathology. Multiple operations were required in eight of 17 patients (47 per cent) who had infected thyroglossal cysts but in only one of 14(7 per cent) with uninfected cysts. In the infected group preliminary incision and drainage was necessary in five cases and cyst recurrence occurred in four (24 per cent), whereas in the uninfected group there was only one recurrence (7 per cent) in a patient with double pathology. Infection and recurrent cysts were the chief reasons for multiple operations. Recurrence was caused by inadequate performance of the correct operation (Sistrunk's) or choice of the wrong operation. Two of our own three recurrences were due to the latter, other pathology being suspected intraoperatively. Histological study of the specimens showed that thyroglossal ducts were frequently multiple and widely spaced. In children any lesion whose presentation is typical of a thyroglossal cyst should be treated with an early Sistrunk's operation. The operation in children who have other pathology has no complications and is justified.