Background <p>Ultrasound-guided biopsies of the salivary glands in pediatric patients are uncommon and can target focal lesions or general parenchyma. Based on open surgical biopsy, 65% of focal lesions have been described as benign. Ultrasound-guided biopsy offers a less invasive initial diagnostic approach.</p> Objective <p>The aims of this study were to assess the diagnostic accuracy and describe indications for ultrasound-guided salivary gland core needle biopsy (CNB) and fine needle aspiration (FNA) in a pediatric cohort.</p> Materials and methods <p>Retrospective single-center study including children who underwent salivary gland biopsy at a tertiary care center from January 2018 to January 2025. Demographics, clinical information, imaging, lesion location, procedure details, adverse events, pathology, and clinical outcomes were reviewed. A descriptive statistical analysis was performed.</p> Results <p>The study included 31 children aged 5&#xa0;months to 17-years-old. The parotid was targeted in 21/31 (68%) and the submandibular in 10/31 (32%). CNB was done in 19/31 patients, 11/31 had a CNB and FNA, and 1/31 FNA only. CNB was diagnostic in 29/30 and FNA in 8/12. When both techniques were used, pathological findings were the same in 7/11. The most common diagnosis was pleomorphic adenoma (<i>n</i>=6). All CNB in cases of malignancy (<i>n</i>=10) were diagnostic. The non-diagnostic case identified was a dermoid cyst in surgery. Nine patients had surgical resections, and the results were consistent with the ultrasound-guided biopsy. No adverse events were identified.</p> Conclusion <p>Ultrasound-guided CNB showed a high diagnostic performance, superior to FNA, in this salivary gland biopsies pediatric cohort.</p> Graphical abstract <p></p>