Thrombosis in children may result in vascular occlusion and a potential loss of viability in skin, limbs or organs, or lead to the development of post thrombotic syndrome. Thrombolysis may prevent such complications, and the use of thrombolytics in children has increased in the last three decades. Despite this, optimum paediatric treatment regimens for these drugs remain uncertain, and accurate efficacy and safety profiles for thrombolytics are limited by the lack of controlled, prospective studies in well-defined patient populations. Restoration of vessel patency has often been achieved but the risk of intracranial and other major haemorrhage secondary to thrombolysis continues to be a significant concern for the clinician deciding on such treatment. This review summarises the use of thrombolytic treatment in children and describes outcome data and adverse events following treatment, as well as the limitations of published studies on paediatric thrombolysis.