When a child is dying of AIDS, what can she understand, and what can her parents bear to tell her? The persons involved in the telling and the manner of disclosure will vary with each child and over time. As more children with Human Immunodeficiency Virus (HIV) live to older ages, the question of when and how to talk with them about their illness becomes more pressing and more widespread.[1] The Centers for Disease Control currently estimates that there are over 4,100 children with AIDS in America, with three times that number of HIV-positive children.[2] Perhaps even without the innovations of improved antiretroviral treatments and early diagnosis, many of these children will live at least to school age. At the younger end--say, before four years of age--few guardians or caregivers desire to tell children the name or other details of their illness. It is said that they are enough. At the older end--say, after fourteen years--few guardians or caregivers seriously doubt that children must be told. It is said that now they are old enough, and sexual maturity presents an issue of public health. Between these ages lies a decade of ethical and clinical obscurity. Observations forming the experiential basis of this article were made in the Harlem Hospital pediatric AIDS facility (Family Care Center) and draw on the (scant) literature about pediatric HIV disclosure.[3] As psychologist to the pediatric AIDS team, I have been struck by how few parents have told their cognitively normal school-age children about their diagnosis. This has been the case even for the majority of symptomatic children, with silence surrounding the issue through the child's death. Of the approximately thirty school-age children treated at Harlem since 1985, only three had been told their diagnosis as of summer 1991. Informal reports from other New York City and Boston hospitals suggest varying (but low) rates of disclosure and a similar range of ethical issues. These ethical questions include the following. Substantively, when is it right to tell children they have a life-threatening illness, in particular the AIDS virus with its high mortality and terrible stigma? What are the ethical grounds for telling or not telling? Is the possible increased anxiety that diagnosis may bring offset by possible gains in intimacy or longer-term psychological adjustment? Are other ethical grounds, such as respect for autonomy, decisive at any point? Procedurally, who should decide whether a child is ready to discuss diagnosis? If parents want silence and others want discussion, under what circumstances should each prevail? Is there a difference, for example, between the (generally infected) natural parent's and a (generally uninfected) foster or adoptive parent's reservations about disclosure? Does the health professional's therapeutic responsibility to the child conflict with a responsibility to the parent?[4] Some factors tend to move the adults who form a child's environment toward disclosure and discussion, while others move them toward silence. In this article I will not examine each of these ethical questions in detail, but sketch common motivations and circumstances that form the context within which the ethical issues arise. A part of this context beyond the scope of the present discussion is the disclosure of children's serostatus to their school and disclosures between parents or within families more generally. My emphasis is clinical rather than legal. As a question of the quality of life for a minor, and given the brief time span in which the question is relevant, disclosure will probably seldom come to adjudication, though it is possible to imagine ways in which that might occur. In New York State, a minor's legal guardian has the prerogative to disclose or conceal the HIV diagnosis. Although it is both somewhat artificial and somewhat problematic to do so, I will begin my sketch of the issues by casting them in terms of a conflict between parents (natural, foster, or adoptive) and health professionals (pediatricians, nurses, social workers, psychologists). …