Introduction. Hepatocellular carcinoma (HCC) is a rare pediatric cancer accounting for 0.5% of all pediatric malignancies. This study examines a large cohort of HCC patients in an effort to define the factors impacting clinical outcomes in pediatric HCC patients compared to adults. Methods. Demographic and clinical data on 63,771 HCC patients (257 pediatric patients ≤ 19 and 63,514 adult patients age ≥ 20) were abstracted from the SEER database (1973–2011). Results. HCC was more common among males (59.5% pediatric and 75.1% adults) and Caucasians (50.4% and 50.5%), p < 0.05 . Children more often presented with fibrolamellar variant HCC (24.1% versus 0.3%, p = 0.71 ) and advanced HCC, including distant disease (33.1% versus 20.8%, p < 0.001 ), and tumors > 4 cm in size (79.6% versus 62.0%, p = 0.02 ). Pediatric HCC patients undergoing surgery (13.107 versus 8.324 years, p < 0.001 ) had longer survival than adult HCC patients. Overall mortality was lower (65.8% versus 82.0%, p < 0.001 ) in the pediatric HCC group. Conclusion. HCC is a rare pediatric malignancy that presents most often as an advanced tumor, >4 cm in Caucasian males. Children with HCC achieve significantly longer mean overall survival compared to adults with HCC, primarily attributable to the more favorable fibrolamellar histologic variant, and more aggressive surgical intervention, which significantly improves survival.