The evidence that splenectomy produces a state of increased risk of late sepsis is now established. That risk is greatest in the child splenectomized in the first 2 years of life, for the initial 3 years after splenectomy, and in disease states previously recognized as producing diminished host defenses. Nevertheless, risk exists in all age groups and all primary disease states.Clinical practice has been appropriately altered. Where possible, elective splenectomy is delayed until risk is diminished. The need for splenectomy for trauma has been decreased markedly as nonoperative management and reparative techniques have emerged. All children should receive pneumococcal immunization and penicillin prophylaxis after splenectomy.