Clinical observations suggest that CH have a poor self-image due in part to isolation from peers imposed by frequent and prolonged medical treatments. The effect on the self image of both C (n=99) and CH (n=24) of spending 2 weeks in a camp attended predominantly by C was tested by the Piers Harris Children's Self Concept Scale. The CH had been on dialysis for 31 ±5 (SE) months and originated from 16 kidney centers located in 12 states. Upon arrival at camp the mean self concept score of CH (52.3 ± 2.3) was lower (p<.01) than that of C (59.8±1.0). CH were found to have more anxiety (p<.001) and scored significantly lower than C (p<.05) in estimating their popularity, happiness, and attitude towards school. There were no differences in self evaluation of behavior or of physical appearance. The camp experience improved the total self concept score in all children (p<.05) but the difference between the groups persisted (p<.05). However, the differences between CH and C in estimation of popularity were no longer detectable (p>.2) and the difference in happiness tended to lessen (.1<p<.05). This study demonstrates that children on chronic hemo-dialysis have a lower self image than most children, particularly in regard to popularity, happiness, and attitude towards school. It also demonstrates that a recreational program which integrates them with their normal peers, has a substantial beneficial effect.