Evaluation of the acute scrotum in the paediatric population may be more difficult than in adults, particularly in boys under the age of five who are often unable to give a detailed history or remain co-operative for a thorough examination. The predominant diagnoses of torsion of the testis, torsion of testicular appendage, epididymo-orchitis (epididymitis), viral orchitis, idiopathic scrotal oedema and tumour generally vary in incidence with age. From 13 years of age to puberty, torsion of the testis is the most common diagnosis, whilst in school age boys the most common diagnosis is torsion of testicular appendage. Epididymitis is less commonly seen in children than in the older, sexually active male, and when present may be associated with an underlying urogenital anomaly. In the under fives idiopathic scrotal oedema and viral causes are most prevalent. Sadly for the urologist, although this trend in incidence with age is observed, all pathologies can occur throughout childhood.