Background: Chemotherapy induced thrombocytopenia (CIT) is a complication of myelosuppressive chemotherapy that often results in delay or dose reduction of subsequent cycles. There are currently no FDA-approved agents for the treatment of CIT. Management consists of platelet transfusions, dose reductions, and delays in subsequent chemotherapy cycles, which can lead to a decrease in progression-free survival as well as overall survival in this patient population. Romiplostim is a thrombopoietin receptor agonist (TPO-RA) that binds to and activates the TPO receptor on megakaryocyte precursors, increasing platelet production. Literature to support the routine use of romiplostim and its application in the setting of CIT in pediatric patients is limited. Objective: To evaluate the safety profile and efficacy of romiplostim in achieving and maintaining platelets ≥ 75,000/mL to allow resumption of chemotherapy without recurrence of CIT in pediatric patients with solid tumors. Methods: This single-center retrospective chart review was conducted at a tertiary pediatric hospital. Patients ≤ 22 years of age were included if they received romiplostim for CIT from July 1 st, 2020, to December 31 st, 2023. The primary outcome of this study was to determine the number of patients who were responsive to romiplostim. Results: A total of 18 patients were included in the analysis. Twenty-eight percent had a diagnosis of rhabdomyosarcoma, 70% of patients had metastatic disease, and 56% had relapsed disease. A total of 12 patients (70%) were responsive to romiplostim, achieving a platelet count ≥ 75,000/μL within 3 weeks. There was an average of 2 dose reductions prior to romiplostim initiation versus 1 dose reduction during treatment with romiplostim (p=0.46) and 3 delays prior to versus 1 delay during treatment with romiplostim (p=0.0008). The average time to platelet count ≥ 75,000/μL was 30 days prior to romiplostim versus 15 days during romiplostim. Conclusion: Romiplostim may decrease the number of chemotherapy dose reductions and delays in pediatric patients with CIT, but further prospective studies are necessary to determine its place in therapy.