Thirty-seven children less than age 19 years were treated from 1985 through 1998 with radiotherapy for symptomatic metastases to bone. The most common primary tumors were neuroblastoma (18), Ewing’s sarcoma (5), and osteosarcoma (5). The interval from diagnosis of the primary tumor to treatment of the first symptomatic metastases involving bone ranged from 0 to 163 months (median 19). Thirty-seven children were treated with 150 courses of radiotherapy. Forty-three courses consisted of a single dose of 300 to 1,000 cGy. One hundred thirteen courses of radiotherapy consisted of five or fewer treatment fractions. Sixteen osseous sites were treated with two courses of radiotherapy and two sites were treated with three. The most commonly irradiated symptomatic bone sites were skull, spine, and hip/femurs. Survival from the first course of radiotherapy administered for metastases to bone varied from 1 to 52 months, with 11 patients (29.7%) surviving 12 or more months and only 3 patients (8.1%) surviving more than 2 years. The majority of children seemed to derive palliation from the radiotherapy based on assessment by family and medical personnel as well as by self-report in older patients. Children with symptomatic metastases to bone have an extremely poor prognosis, and short courses of radiotherapy are suggested as palliation. Repeat courses of radiotherapy can be given for persistent or recurrent symptoms.