Background: Chronic myeloid leukemia remains a rare disease in children accounting for 2-3% of all childhood leukemias.The field has witnessed great advances in the understanding of it's molecular biology and therapeutics. Methods: Various therapeutic advances in the field have been reviewed. Special focus is on emerging treatments: especially oral tyrosine kinase inhibitors which target the activity of the bcr-abl tyrosine kinase. Results: Initially therapy revolved around early allogenic stem cell transplantation. The introduction of the oral tyrosine kinase inhibitor imatinib and other such molecules has however changed the management paradigm. The high response rates and excellent tolerance to initial therapy has tilted the balance away from allogenic stem cell transplantation. Conclusions: Better understanding of the molecular basis of disease has resulted in the availability of a plethora of agents whose potential has yet to be fully explored. Treatment paradigms in children are in a state of flux : especially relating to the role and timing of the stem cell transplant and its integration with imatinib and other therapies.