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Purpose: To evaluate a hand-held portable autorefractor in a pediatric population and compare results with those found on retinoscopy by experienced pediatric retinoscopists., Methods: One-hundred and two children aged 5 to 72 months were examined with and without cycloplegia using an autorefractor, and the results compared with those found on standard retinoscopy by two ophthalmologists masked as to the autorefractor findings. Results were converted from conventional notation using plus cylinder to the h-space notation and compared in three-dimensional h-space., Results: There was remarkable agreement between the results found by autorefraction and manual retinoscopy using loose lenses or a phoropter. The findings were similar both for sphere and cylinder across the age ranges studied., Conclusions: The Nikon Retinomax is an accurate instrument to estimate refractive error in children younger than 6 and could prove useful in the office, the operating room, or as a screening device.