Abstract: Objective To analyze the ultrasonic imaging characteristics of juvenile xanthogranuloma (JXG) in children with atypical skin lesion colors and discuss with considerations of pathological staging to enhance the understanding of this disease. Methods Retrospective analysis was conducted on 28 children who were diagnosed with atypical colored JXG through histopathological examination at Xuzhou Children's Hospital Affiliated to Xuzhou Medical University from January 2020 to July 2025. Their clinical data, pathological features, and ultrasound findings were analyzed. Results Among the 28 children, 14 were male and 14 were female. The lesion colors were red in 12 cases (42.9%), purple-blue in 2 cases (7.1%), and skin-colored in 14 cases (50.0%). The lesions were located in the dermis and subcutaneous fat layers, with some extending to the superficial muscle layer. Ultrasound findings showed hypoechoic in 15 cases (53.6%) and mixed echogenicity in 13 cases (46.4%). Clear boundaries were observed in 23 cases (82.1%) and unclear boundaries in 5 cases (17.9%). Nodule types included small nodules in 12 cases (42.9%), large nodules in 12 cases (42.9%), and giant nodules in 4 cases (14.2%). According to the Alder blood flow grading, grade 0 was observed in 14 cases (50.0%), grade Ⅰ in 7 cases (25.0%), and grade Ⅱ in 7 cases (25.0%). Staging of the lesions showed early stage in 10 cases (35.7%), mature stage in 13 cases (46.4%), and regressive stage in 5 cases (17.9%). Statistical analysis revealed significant differences in sex and ultrasonic echo characteristics across different pathological stages (P<0.05). Conclusions The ultrasound characteristics of pediatric atypical colored JXG are closely related to different pathological stages, with certain distinguishing features that provide valuable reference for clinical diagnosis and treatment.