In 24 sacrococcygeal teratomas, three, or 13 per cent were malignant before the age of two. All three of the patients with malignancy had bowel or bladder dysfunction, and two of the three developed pulmonary and hepatic metastases. The operative mortality rate was less than four per cent. Survival rate in the benign tumors was 100 per cent. There were no survivors in the malignant group. Sacrococcygeal tumors in infants can usually be resected, even if extremely large, with appropriately aggressive surgery. Intraoperative monitoring is vital in these procedures. The coccyx from which these teratomas originate should be excised en bloc with the mass. Certain cases require a combined abdominosacral approach.