The authors report the incidence and characteristics of sixth cranial nerve palsy in paediatric patients with intracranial hypertension. A retrospective review of records was performed in central Ohio over a three year period and nine children were found to have unilateral or bilateral sixth nerve palsy. Five of the children had idiopathic intracranial hypertension (IIH), whereas the remaining four had secondary intracranial hypertension from cerebral venous sinus thrombosis (two cases) and infection (two cases). In the reported cases, all recovered without treatment. Papilloedema was present in eight of the nine cases (89%) and all cases resolved with treatment of intracranial hypertension. Aside from papilloedema, sixth nerve palsy is the most common neurological finding in paediatric IIH. This occurs because of elevated intracranial pressure which results in a downward displacement of the brainstem that stretches the sixth cranial nerve as it crosses over the petrous ridge. The authors suggest further studies to compare paediatric patients with different types of intracranial hypertension to explore important differences.