The purpose of this study was to update physicians' self-reported initial management practices for childhood idiopathic thrombocytopenic purpura (ITP) from an initial survey in 1997. A questionnaire was sent by e-mail in October 2001 to 753 members of the American Society of Pediatric Hematology/Oncology (ASPH/O). The questionnaire had 14 questions, based on the clinical presentation of a 5-year-old boy with ITP, a platelet count of 7,000/microL, scattered petechiae, and no mucous membrane bleeding. Two hundred eighteen (29%) surveys were returned. In response to questions regarding initial treatment, 33% of physicians said they would always administer drug therapy, 38% usually, 15% sometimes, and 14% rarely/never. When asked which agent would be used if drug treatment were prescribed, 45% reported anti-D, 33% IVIG, 20% prednisone, and 2% other regimens. Only 34% of physicians would always or usually hospitalize such a patient. Hospitalization was more likely if a physician responded that he or she would always or usually use drug therapy. Physicians who saw more ITP patients were more likely to self-report sometimes or rarely/never prescribing drug therapy. Self-reported initial management of ITP by ASPH/O members in 2001 is similar to 1997 regarding the percentage of pediatric hematologists who would not use drug therapy. Among physicians who would use drug treatment, there was an increased use of anti-D and decreased use of IVIG and prednisone. This information provides the basis for designing a randomized clinical trial to compare the effect of different management strategies on the outcomes of bleeding symptoms, side effects of therapy, costs, and quality of life.