Objective To discuss the indications, surgical techniques, efficacies and complications in the treatment of pediatric humeral diaphyseal fractures with elastic stable intramedullary nail （ESIN）. Methods A retrospective study was conducted for all pediatric humeral diaphyseal fractures with ESIN treated at our hospital between 2004 and 2012. The complete clinic data were collected from 57 patients aged 24-173 months. The mean follow-up period was 17 months. The humeral fracture sites were proximal third （n = 10）, middle third （n = 29） and distal third （n = 18）. The surgical indications included unstable fractures, failure after conservative treatment, open fractures or associated multiple injures. And the manners of surgical techniques were antegrade （n = 5）, radial retrograde （n = 21） and bilateral retrograde （n = 31）. Results Bilateral retrograde manner could provide the stability for middle and distal thirds of humeral shaft fractures. Two cases of radial retrograde manner had angular displacement while 3 cases of antegrade manner translational displacement for distal third. And external immobilization should be combined. All fractures united without abnormal appearance or decreased range of motion. Among 9 patients with skin irritation, three of whom developed nail protrusion through skin. There was no occurrence of infection, neurovascular injury or secondary fracture displacement. Conclusions ESIN provides an option for stabilizing pediatric humeral diaphyseal fractures. The technique of bilateral retrograde insertion is secure, simple and effective.