Visceral fat begins to accumulate in early childhood. Even before puberty there is tremendous variation in the degree to which visceral fat exists in children. Some of the inter-individual variation is explained by multi-colinearity with other adipose stores, but there is also a portion of the variance in visceral fat that is completely independent of other adipose tissue stores. Ethnic differences in visceral fat exist, with African American, pre-pubertal children having relatively less visceral fat. Sex differences in fat distribution begin to emerge during pubertal development, with men having greater visceral fat than women. Obesity status or maturation may affect relationships between abdominal adiposity and cardiovascular risk; visceral fat may have more of an impact on metabolic health in obese children and adolescents, whereas subcutaneous abdominal fat may be more important in younger and/or less obese individuals. Ethnicity appears to affect the relationship between fat distribution and cardiovascular risk, with the association between subcutaneous abdominal fat, and basal and postchallenge insulin, being significant in African-American, but not Caucasian, children. Given the small number of studies conducted on fat distribution and cardiovascular disease risk factors in children, there is certainly a need for additional research in this area, particularly regarding how the early development of visceral fat affects long-term cardiovascular disease risk.