Bone lesions are commonly seen when reporting pediatric skeletal imaging. Distinguishing aggressive from nonaggressive lesions is essential in making the diagnosis. Not all aggressive lesions are neoplastic; indeed, osteomyelitis frequently presents with aggressive appearances and is far more commonly seen in the pediatric population than neoplastic lesions. In this article, we discuss an approach for the diagnosis of pediatric bone tumors and tumor-like conditions. The most common pediatric benign and malignant bone tumors are discussed in more detail.