Recent advances in the treatment of pediatric tumors led to an improvement of survival in this population. As a result, many pediatric survivors experience long-term effects that impact their quality of life. Therefore, it is extremely important to identify new treatment approaches that may target the tumor minimizing the drug-related side effects. Over the past 10 years, remarkable advances in nanomedicine have provided several potential tools for cancer treatment. Recently, there has been a growing interest towards therapeutic nanocarriers in the pediatric field, since they represent a new strategy to enhance the drug efficacy and reduce the toxicity. Various nanoformulations have been developed to improve the targeting and the release of antitumor compound to cancer cells in pediatric tumors and clinical trials have been conducted or are ongoing. Exosomes are nanometer-sized vesicles that play a crucial role in mediating intercellular communication. Thanks to to their intrinsic cell targeting properties, stability in the circulation, and bio-compatibility, they are emerging as new promising vehicles both for drugs and biological therapeutics. Moreover, these nanovesicles are a reservoir of potential diagnostic and prognostic markers. In this review, we describe recent advances in the treatment of pediatric tumors through nanodelivery system with particular attention to neuroblastoma, soft-tissues/bone sarcomas and pediatric brain tumors. Furthermore, we explore the potential role of exosomes as an effective option of nanodelivery providing insights into their characteristics in pediatric tumors and their use in adult clinical trials.