Our objectives were to determine the treatment outcome of trigger thumb and to identify its possible cause. One hundred and thirty-eight thumbs from 115 children were reviewed. There was an overall success rate of 66% following conservative treatment and the success rate appears to be higher in the younger age group and in those treated with splint therapy, which includes wearing a splint and regular therapy exercises. The outcome of the children who underwent surgery was good with a recurrence rate of 1.4% and a wound infection rate of 2.8%. Our results suggest that a more conservative approach to this problem should be adopted. Our data also suggest that this condition may be acquired rather than congenital.