Background: Although there are well-established guidelines for intravenous thrombolysis (tPA) and mechanical thrombectomy (MT) in adult acute ischemic stroke (AIS), limited data exists in children. This study aims to investigate current trends in the utilization of tPA and MT in the pediatric AIS population and identify predictors of use. Methods: We identified all patients <=20 years (weighted n=3,452) with a primary diagnosis of AIS in the KIDS Inpatient Database from 2009-2016. Age-specific rates of utilization of tPA and MT were calculated. Multivariable-adjusted logistic regression models were used to evaluate predictors of tPA and MT use. Results: Across the study period, 44.8% of AIS admissions were girls, and the mean age was 7.5 years (y). The overall frequency of usage of tPA was 5% and MT was 2.3% but this differed significantly by age (tPA 0-4y 0.5%; 10-14 y 4.5% and MT 5-9 y 2.4% vs 15-20 y 3.5 %). Overall tPA use increased by >100% over time: 2.5 % in 2009 to 6.3 % in 2016, but most of this increase was seen in patients 10-14 y and 15-20 y (figure 1). MT use more than doubled across the study period from 0.98 % in 2009 to 2.8 % in 2016 with the greatest increase in patients 15-20 y (figure 2). After multivariable adjustment for clinical and demographic factors, tPA use increased with age (10.8, 95%CI 2.8-41.3, for ages 15-20 vs 0-4 y). Compared to ages 0-4 y, patients 5-9 y had marginally significantly greater odds of MT use (7.6, 95%CI 1.2-48.4). There was no significant difference in odds of tPA and MT use by race and sex but patients hospitalized in the west were more likely to undergo MT compared to those in the Northeast (OR 3.7: 95%CI 1.4-9.7, p=0.008). Overall in-hospital mortality was 10.6% and this did not change significantly over the study period (p=0.791). Conclusion: Usage of tPA and MT in pediatric AIS patients increased in the US over the last decade but in-hospital mortality has not changed over time. Future studies targeted at improving stroke mortality in children are needed.