Context Childhood soft tissue sarcomas represent approximately 6-8% of all paediatric cancers, with quoted incidence of 5-9.1/million. Rhabdomyosarcoma comprises the majority of cases. Age distribution shows highest incidence in infants, with nearly half of cases occurring before 5 years, and male predominance. Risk factors include genetic syndromes, environmental exposures and socioeconomic factors. Our study aims to review the incidence of paediatric soft tissue sarcomas in Victoria, exploring patient demographics, tumour site, diagnostic modality, histopathological grading and treatment. Method A retrospective review of all new head and neck (H&N) soft tissue sarcoma diagnoses in Victoria, treated through a statewide Paediatric Integrated Cancer Service and Victorian Children Cancer Centre between July 2019 to June 2024. Results There were 23 new diagnosis of paediatric H&N soft tissue sarcoma, with a mean age of 8.5 and age range of 3 months-18 years and a male predominance of 2.3:1. The majority (73.9%) were rhabdomyosarcoma, others included 2 synovial sarcoma, 2 undifferentiated sarcoma, clear cell sarcoma, and rhabdoid tumour. Of the 17 patients with rhabdomyosarcoma; 6 presented with orbital mass and 4 with facial/cheek/lip mass. The remainder included 3 in the paranasal sinuses presenting with nasal obstruction, 3 in the temporal bone, and 1 pharyngeal. Some had comorbidities or genetic syndromes eg. Neurofibromatosis. Diagnoses were made with incisional or core biopsy. Treatment included a combination of chemotherapy regime, radiation and surgery based on site and staging. Discussion Paediatric H&N soft tissue sarcomas are rare tumours but ones that otolaryngologists should be cognisant of. A child presenting with a non-congenital, non-infectious, non-inflammatory H&N mass without systemic symptoms may indicate a malignant diagnosis. FNA is not recommended and urgent core or incisional biopsy should be considered if clinical/radiological features are suspicious.