Percutaneous endoscopic gastrostomy (PEG) tube placement is routinely performed in children with special nutritional needs. For convenience and cosmetic reasons, many parents prefer a skin-level, nonrefluxing, (“button”) gastrostomy tube. After healing of the track, a button gastrostomy tube can replace a PEG but this requires a second procedure. This study assessed the technique and complication rate of placement of a button gastrostomy tube mounted for endoscopic placement as the initial procedure. Seventeen patients (10 males), ages 4 months to 12 years were studied. All patients underwent successful placement of the button under conscious sedation using a standard endoscopic push technique. In the first 10 patients, an 18 French device was used. Four patients developed migration of the device into the track between 9 and 55 days after placement and the button was removed. Migration was preceded or accompanied by a wound infection in 3 of the 4 patients. In the next 7 patients, a larger, 24 French button was used without any wound infections or migration of the device. In thirteen patients with successful placement, a follow-up period of 110–450 days has revealed no further complications. Placement of the button gastrostomy tube in infants and children can be accomplished using standard endoscopic techniques. However, further study of the optimal size of the device and optimal placement procedure to prevent wound infection and migration should be undertaken.