Knowledge is currently limited about West Nile virus (WNV) infection and its sequelae among children. Available evidence suggests that when compared with adults, children less than 18 years old can be at high risk for WNV exposure and infection yet manifest a lower risk for WNV-related morbidity and mortality. We detail clinical features of pediatric West Nile-associated neurologic disease (WNND) epidemic cases in Cuyahoga County during 2002. We present a structured review of pediatric and adult WNND cases hospitalized in Cuyahoga County, Ohio. During the epidemic, 5 children were hospitalized with confirmed WNND (estimated incidence = 1.4/100,000 children 5-17 years old at risk). Compared with adults, children had shorter hospitalization (mean, 4.6 versus 12.3 days), fewer neurologic symptoms, better neurologic outcomes, and lower mortality (0% versus 5.3%). Cerebrospinal fluid results were similar. When compared with adults, children had significantly lower rates of WNND. Children are at a decreased risk for severe WNV and less likely to present with neurologic signs or suffer neurologic sequelae.