Chronic hepatitis B infection has been identified as an important risk factor for developing hepatocellular carcinoma (HCC) especially in the presence of hepatitis and liver cirrhosis. However, here we describe an unusual case of a child with chronic hepatitis B infection who developed HCC in the absence of active hepatitis or cirrhosis. This case serves to highlight the importance of regular HCC surveillance for all children with chronic hepatitis B, regardless of presence or absence of hepatitis or cirrhosis.