Purpose of review The current review will focus on the current knowledge of the contribution of both germline and somatic mutations to the development and management of cancer in pediatric patients. Recent findings It has long been thought that genetic mutations in both germline and somatic cells can contribute to the development of cancer in pediatric patients. With the recent advances in genomic technologies, there are now over 500 known cancer predisposition genes. Recent studies have confirmed an 8.5-14% germline mutation rate in cancer predisposition genes in pediatric cancer patients. Summary The discovery of both germline and somatic cells mutation(s) in pediatric cancer patients not only AIDS in the management of current disease, but can also have direct implications for future management as well as the medical management of family members.