Introduction: In children, esophageal replacement (ER) is considered a primary or salvage treatment modality for esophageal atresia (EA), or to treat complications related to caustics, button batteries, iatrogenic, or other esophageal injury. There is a lack of consensus regarding which type of ER is best. Methods: A review of the English-language literature regarding ER in the pediatric population was undertaken. Perioperative outcomes, as well as advantages and disadvantages of each type of ER were abstracted, study quality (GRADE) was assigned, and evidence-based recommendations provided. Results: The most common types of ER include gastric (GI), colonic (CI), and small bowel-based interpositions (jejunal [JI]). A total of 22 studies (3 CI, 5 GI, 5 JI, 9 combination) met inclusion criteria. The majority were deemed low quality, while five had moderate quality evidence. Conclusion: The best esophageal replacement is the one that is not needed. If replacement is required, patients should be referred to a center with significant expertise in ER where the choice of ER to pursue should be center-dependent, considering patient characteristics and local expertise. Yet, if expertise and resources allow, the supercharged JI appears to have the best morbidity profile and functional outcome of the ER options. Multidisciplinary long-term follow-up of ER patients is essential.