Peritoneal surface malignancy (PSM) in children is a rare occurrence and requires the collaboration of a multidisciplinary team in order to achieve optimal outcomes. PSM typically arises from intraperitoneal dissemination of tumor that may originate from a variety of primary tissues such as colorectal, gastric, ovarian, and mesothelium. It is characterized by extensive peritoneal involvement, and metastatic spread may extend to abdominal and retroperitoneal lymph nodes, as well as solid organs such as the liver and spleen. Historically, prognosis has been extremely poor despite multimodal therapy; however, the use of cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to prolong overall and recurrence-free survival. This review discusses the epidemiology, clinical and radiographic characteristics, workup, and surgical management for PSM in children.