Introduction Head and Neck malignancy in children is different to that of adults. This study seeks to determine the incidence of head and neck malignancy in children. The secondary aim is to explore their demographic, presenting complaint and method of diagnosis to inform future practice. Method A five-year retrospective review of the statewide solid tumour multidisiciplinary meeting at Royal Children’s Hospital, a tertiary paediatric oncologic referral centre, was undertaken. The inclusion criteria comprise all new and recurrent malignant diagnosis between July 2019 to June 2024 in those under 18. Information regarding age, gender, anatomical site, histopathology, oncologic staging, method of diagnosis were collected. Results A total of 2,103 case discussions was documented. 820 patients with new or recurrent malignant diagnosis were included. There were 453 (55.2%) males and 367 (44.8%) females with overall mean age of 8.5 years. Of these 820 patients, 189 (23.0%) were malignancies which involved a head and neck anatomical site. Hodgkin's lymphoma is the most prevalent H&N malignancy, accounting for 93 cases (49.0%) of all diagnosis. Non-Hodgkin lymphoma makes up 8.5% and the next 2 big groups are Langerhans Cell Histiocytosis (LCH) and soft tissue sarcomas at 14.3% each. Also recorded was thyroid malignancy (5.3%), neuroblastoma (3.2%) and other rare tumours. 73.1% of patients who were diagnosed with lymphoma did not present with constitutional symptoms. Fine needle aspirate cytology was only useful if the malignancy suspected was thyroid. Discussion Of all new diagnosis of malignancy in children over a 5-year period, 23.0% involved a head and neck anatomical site, which is significant to the practicing otolaryngologist. Lymphoma, LCH and soft tissue sarcomas were the 3 most common pathologies. Emphasis on the presence of constitutional symptoms should be reduced as the majority of those with lymphoma did not present with them.