Objective To investigate the safety and therapeutic effect of extracorporeal shock wave lithotripsy(ESWL) in the treatment of upper urinary tract calculi in children. Methods ESWL was employed to treat 300 cases of upper urinary tract calculi in children who aged from 7 months old to 10 years old. Among the 300 cases, 202 cases were renal calculi, and the other 98 cases were ureteral calculi. A second ESWL was performed for those with urinary obstruction or residual calculi 1 week to 3 months after first ESWL. The therapeutic effect was evaluated 3 months after first ESWL. Results Among the 202 case of renal calculi, 169(83.66%) were cured after first ESWL, 32(15.84%) were cured after a second ESWL, and one case failed and then received percutaneous nephrolithotomy. Among the 98 cases of ureteral calculi, 84(85.71%) were cured after first ESWL, 13(13.27%) were cured after a second ESWL, and one case failed and received laser lithotripsy. The overall cure rates of renal calculi and ureteral calculi 3 months after first ESWL were 94.55% and 98.98%, respectively, and no serious complications were observed. Conclusion ESWL may be a safe and effective treatment for upper urinary tract calculi in children.