To investigate the attitude of Belgian pediatricians toward the management and treatment of children with suspected acute pyelonephritis, a short letter was sent to all Belgian pediatricians (1,200). It contained a brief description of a clinical case strongly suggestive of acute pyelonephritis followed by a series of questions centered on complementary examinations to be performed, need of hospitalization and treatment. A total of 583 responses were received (49%). In the acute phase, 99% of pediatricians perform urine cultures, 87% blood examinations, and 76% renal ultrasound. Dimercaptosuccinate (DMSA) scintigraphy is performed during the acute phase by 37% and during follow-up by 32% of all pediatricians. A voiding cystogram is requested by 71%. Ambulatory treatment is considered by 30% of responders. Amoxicillin/clavulanic acid (44%) and trimethoprim/sulfonamide (22%) are the most frequently used oral antibiotics. Private pediatricians perform fewer examinations and more frequently consider ambulatory treatment of acute pyelonephritis, compared to pediatricians working in hospitals. Among Belgian pediatricians, attitudes toward the diagnosis and treatment of acute pyelonephritis are heterogeneous. This survey underlines the need for properly documented prospective studies for the evaluation of different treatment modalities in childhood acute pyelonephritis.