Sixth nerve palsy can occur as a result of elevated intracranial pressure, neoplasm or trauma. Reports from tertiary centers indicate between 5-16% of cases referred have no etiology ascribed and are classified as benign. Rarely, these benign palsies can recur. A retrospective chart review of a cohort of 253 pediatric patients with sixth nerve palsies was analyzed and uncovered 30 patients with benign sixth nerve palsy, 9 of which recurred. Our data and review of other studies on the subject imply that children presenting with a new onset sixth nerve palsy can be benign in approximately 13% of cases and a thorough history and physical to evaluate for any other neurological symptoms or signs followed by MRI of the brain with and without contrast is recommended.