Between 11 and 18% of nasopharyngeal carcinomas (NPC) occur in the paediatric age group but there are no specific management guidelines for this age group. Tunisia is a region with an intermediate incidence of NPC, the authors studied 40 cases under 17 years of age treated for NPC over an 18-year period (6% of all NPC cases). The median age was 14 and the sex ratio 1:3. The presenting complaint in 90% of cases was a cervical swelling followed by nasal obstruction and hearing loss. In patients without metastases, the primary treatment was three cycles of chemotherapy followed by radiotherapy to the nasopharynx and to the neck fields on both sides. The mean follow-up was 66.5 months. The overall survival rate at five and 10 years was 77.7% and disease-free survival was 75%. The main prognostic factors were T-stage and total remission with radiotherapy. The main acute toxicities were mucositis and radiodermatitis. Delayed toxicities were in the form of xerostomia, growth retardation and menstrual dysfunction. The authors conclude that paediatric NPC is readily treatable but with the current regimens, the morbidity is still quite high.