Objective: To investigate the clinical characteristics of pediatric sialolithiasis, which are distinct from those of adult sialolithiasis. Methods: A total of 210 patients with sialolithiasis confirmed by surgical treatment were enrolled in the study from Samsung Medical Registry (1995-2005). Twenty-nine were pediatric patients (age ≤18 years) and 181 adult patients (age >19 years). Comparison of pediatric and adult sialolithiasis was performed in terms of subject characteristics, clinical manifestations, salivary calculi characteristics, treatment modalities and outcomes. Results: Postprandial recurrent swelling was the most frequent complaint in pediatric sialolithiasis patients, as similar as in adult patients. However, duration of symptoms was shorter in pediatric patients (mean 14.1 months versus 30.7 months, P = 0.003). Most calculi were less than 1 cm in pediatric patients (93.1%), compared to 56.3% of the adult patients (P = 0.001). The calculi were located more in the distal duct (62.0%) than in proximal duct and gland in the pediatric patients, whereas 44.7% in the adult patients (P = 0.038). Conclusion: Because of large proportion of relatively small and distal sialolithiasis in pediatric patients, bimanual careful palpation of the oral cavity is mandatory to diagnostic approach for children suspicious of sialolithiasis. These findings also suggest that intra-oral approach is effective treatment procedure for most of sialolithiasis in children. © 2007 Elsevier Ireland Ltd. All rights reserved.