We investigated the performance of aspartate aminotransferase to platelet ratio index (APRI) as a noninvasive marker of fibrosis and cirrhosis in children with chronic viral hepatitis. All of the patients 0 to 20 years old with chronic hepatitis B or C presenting at a tertiary medical center from 1992 to 2008 were identified. Thirty-six patients were evaluated with 48 biopsy results. The areas under the receiver operating characteristic curve were 0.71 for fibrosis and 0.52 for cirrhosis. When examining subgroups, the APRI performed better in older patients and in those with vertically transmitted hepatitis C virus. Further research into APRI and the other noninvasive markers of fibrosis in children with chronic viral hepatitis is warranted.