Background: The prognosis for pediatric acute myeloid leukemia (AML) has improved recently. This study was aimed to describe the epidemiology, the changes of treatment strategies and improvement of outcomes in Gwangju-Chonnam children with AML over 2 decades. Methods: The medical records of 116 children with newly diagnosed AML were retrospectively reviewed. After excluding patients with acute promyelocytic leukemia, 91 patients were investigated for the demographic characteristics, prognostic groups including cytogenetic risks, treatment protocols, and survival rates over the periods of 1996-2005 ( Period I, n=53), and 2006-2015 ( Period II, n=38). Results: Annual numbers of AML have decreased with contraction of childhood population. The 5-year Kaplan-Meier (K-M) estimated overall survival (OS) and event-free survival (EFS) for 110 AML patients were 53.2±5.1% and 43.8±5.1%, respectively. The 5-year OS rate was significantly improved during period II (70.3±7.0%) as compared to period I (40.0±6.8%) ( P=0.001). Among 91 patients, the 5-year OS rate was significantly improved during period II (61.6 +/- 8.6%) as compared to period I (34.1 +/- 7.3%) ( P=0.007). And the 5-year EFS were 47.7 +/- 8.9% and 26.1 +/- 6.9%, respectively ( P=0.024). The 5-year OS rate in cytogenetic risk groups were not significantly different ( P=0.11). Fifty-eight patients underwent hematopoietic stem cell transplantation (HSCT). The K-M 5-year estimated survival for transplanted patients was 53.7±7.0%, while that of chemotherapy only patients was 30.1±9.1% ( P=0.014). Survival was compared by stem cell sources: matched sibling donor fared the best outcome of 80.0+/- 10.3%, followed by unrelated bone marrow/peripheral blood (60.2 +/- 12.1%), umbilical cord blood (41.7 +/- 22.2%), and autologous blood (28.8 +/- 13.1%) ( P=0.000). Among prognostic factors, treatment modality was the only independent factor. Chemotherapy only group had a relative risk of 2.06 for death as compared to transplantation group ( P=0.015). Conclusion: The survival of Korean children with AML has improved to the level comparable to developed countries over 2 decades, due to change of induction strategy, better supportive care with economic growth, refinement of HSCT techniques including better selection of patients based on prognostic groups, and stem cell donor selection.