Ethylene glycol is a serious toxin that children frequently ingest. Diagnosis and treatment of this poisoning are challenging and frequently involve the use of novel therapies. In the past year, fomepizole (4-methylpyrazole) has been approved for use as an antidote in the treatment of ethylene glycol poisoning in adults, and the first article reporting the use of fomepizole in a pediatric ethylene glycol exposure was published. As a result, the therapy of ethylene glycol poisoning in children is likely to change from the traditional approach of ethanol administration coupled with hemodialysis to the administration of fomepizole with or without hemodialysis. Curr Opin Pediatr 1999, 11269–273 © 1999 Lippincott Williams & Wilkins, Inc.