The majority of neck masses in the pediatric population are congenital or inflammatory in origin requiring a thorough understanding of embryology and anatomy of the cervical region. However, malignancy must always be ruled out as they represent 11%–15% of all neck masses in the pediatric population. The initial history and physical are of utmost important to correctly work-up and eventually diagnose the lesion. This article addresses many aspects of the workup, diagnosis and eventual proper surgical or medical management of pediatric neck masses.