Twenty children with proven (n = 12) or probable (n = 8) invasive fungal infections received caspofungin treatment either as first-line (n = 7) or as salvage (n = 13) therapy and as monotherapy (n = 5) or in combination (n = 15). Eleven had aspergillosis, 7 had candidiasis, and 2 had Rhodotorula infections. Caspofungin was well tolerated. Nine patients experienced 11 drug-related adverse events, none were severe, and none led to drug discontinuation. Caspofungin as a first-line treatment was successful in 5 of the 7 children (these 5 patients survived the infectious episode, with a follow-up of 147 days), and salvage therapy rescued 8 of 13 children, but only 5 of them survived.