Background: trigger thumbs in children predominantly present with flexion deformity and a nodule at the MCP joint. Surgical release with a transverse incision and splitting of the A1 pulley achieves good cosmoses and attains a satisfactory range of motion with minimal complications. Aim of the Work: to analyze the results of treatment of congenital trigger thumb by open surgical release. Patients and Methods: this study was carried out on 12 patients with congenital trigger thumb treated by surgical release of A1 pulley after obtaining the hospital's Research Ethics Committee approval and written informed consents from the patients. Results: twelve patients were followed up for a mean of 10 (range 4–16) weeks, by which time they were all free of pain and had normal strength subjectively. Of the 12 patients evaluated postoperatively, all were able to fully extend the interphalangeal joint of the involved thumb. Conclusion: Surgical management is the most common treatment, and this is done effectively and safely in the hands of experienced surgeons with pediatric anesthesiologists.