MR spectroscopy of the pediatric brain now has entered the clinical arena as a result of enhanced technology, complementary new sequences, and proof of clinical utility. Armed with a knowledge of the variation in metabolite concentrations over time, with myelination and brain growth, proton MR spectroscopy can be helpful in differential diagnosis, management, and prognostication of pediatric disease processes. Although other molecules can be interrogated, hydrogen proton spectroscopy is the mainstay. The development of multiplanar techniques, performed in a time-efficient fashion, has enabled more robust spectra to be obtained from larger volumes of brain, permitting spatial localization of different metabolites, such as lactate. With the introduction of gene therapy and other new interventions, a noninvasive tool such as MR spectroscopy may prove to be invaluable.