Background: Type 2 diabetes (T2DM) in children is considered rare before puberty. Objective: Describe the characteristics and outcomes of children with T2DM diagnosed at or before 10 years of age. Methods: Retrospective electronic medical record review of children diagnosed with T2DM at a University Children's Hospital over 12 years was conducted. Patient characteristics at diagnosis, 2-3-year follow-up, and 4-5-year follow-up were analysed as a whole and by age groups, 5-8 and 9-10 years. Results: There were 42 children ≤ 10 years with T2DM (5-8-year age group, n = 8 and 9-10-year age group, n = 34). There were 88.1% African American, 11.9% Caucasian, and 88.1% females. Body mass index (BMI) was ≥95th percentile in 95.2%. Average BMI z score was 2.5 ± 0.4 and higher in the 5-8-year age group (2.7 ± 0.5 vs 2.4 ± 0.4, P =.02). Average haemoglobin A1C at diagnosis was 10.5 ± 2.4%, and improvement was seen at 2-3 years, but subsequent worsening was noted at 4-5 years in both age groups. At 4-5 years after diagnosis, 93.9% required insulin for management of their hyperglycaemia, 21.2% had hypertension requiring treatment, 28.6% had low-density lipoprotein ≥130 mg/dL, and 28.6% had high-density lipoprotein <40 mg/dL. Conclusions: T2DM at or below 10 years of age disproportionately affected females and ethnic minorities and was associated with morbid obesity. The majority of these children did not achieve glycaemic control and required insulin for management of their hyperglycaemia after 4-5 years, indicating the need for increased awareness of T2DM and intensive treatment in this special group.