Proton therapy enables normal tissue sparing for curative-intent treatment of children with cancer who require radiation therapy. In the USA and elsewhere, proton therapy is being rapidly adopted, and many new proton centres are being established. Without a proton centre in Canada, children and their families must travel abroad for treatment at high cost and has raised the question whether a Canadian proton therapy facility is needed. METHODS: Canadian Pediatric Oncology centres were surveyed to assess current and future clinical practices. Needs were modeled by screening the Alberta Cancer Registry, ascertaining the number of children eligible for proton RT and comparing to the number who actually received this therapy. RESULTS: Most centres (63%) referred children, and 49 children were referred abroad between 2008 and 2013. Referrals were estimated to increase to 36 cases per annum across Canada. Most respondents (75%) supported that proton therapy will reduce late effects in most or selected cases compared to photon therapy. The registry search revealed 37,170 patients irradiated of which 379 children (1.0%) were potentially eligible for proton therapy, accounting for 15.9% of the new cases of childhood cancers diagnosed in Alberta over the interval. CONCLUSIONS: A strong perceived need for a pediatric proton therapy in Canada was identified. Proton therapy utilization was lower than modeled needs. Future referrals are anticipated to increase, with annual estimated cost of approximately $60 million spent outside of Canada that could be invested within the Canadian health care economy. These issues are worthy of further national discussion.