Wilms tumor (WT) is the most prevalent urologic malignancy in childhood. Nonetheless, the genetic factors underlying WT remain largely unknown. The miR-423 rs6505162 C>A polymorphism is associated with the susceptibility to numerous cancers; however, no investigations have been conducted on its association with WT. To evaluate the correlation between the miR-423 rs6505162 C>A polymorphism and WT risk in Chinese children, we genotyped this polymorphism using the Taqman method in 145 cases and 531 cancer-free controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to estimate the strength of the association. The results showed that the rs6505162 CA genotype was associated with decreased susceptibility to WT (CA versus CC: adjusted OR=0.65, 95% CI=0.42-0.99, P=0.047). In the stratified analysis, we found that CA/AA genotypes conferred a significantly decreased overall risk of WT in children younger than 18 months (adjusted OR=0.30, 95% CI=0.14-0.63, P=0.002) and those with clinical stage I+II WT (adjusted OR=0.42, 95% CI=0.20-0.85, P=0.017) when compared with CC genotype. In summary, the miR-423 rs6505162 C>A polymorphism may negatively modify WT susceptibility in Chinese children. Our findings should be validated in larger studies involving other ethnicities.