Approximately 20–30% of patients with inflammatory bowel disease (IBD) are diagnosed during childhood or adolescence. Pediatric ulcerative colitis (UC) is associated with more extensive and aggressive disease compared to adult-onset UC, with up to 40% of pediatric patients requiring colectomy within 10 years of diagnosis. Restorative proctocolectomy with ileal pouch anal anastomosis (RP-IPAA) is the procedure of choice for pediatric UC patients and can be performed in 1-, 2-, or 3-stages. Although the 3-stage approach has been perceived historically as the safest approach to prevent anastomotic leak and pelvic sepsis, complications that can have devastating long-term consequences, current review of the pediatric UC literature suggests that in highly select patients, the 2-stage approach may be a safe and feasible alternative with comparable postoperative outcomes, functional outcomes, and quality of life. The decision to proceed with a 3-stage approach or an alternative staged approach should rely on multiple factors and considerations, including patient factors (ex. disease severity, steroid/immunomodulator therapy, nutritional status, concerns for fertility, diagnosis of IBD-unclassified [i.e. indeterminate colitis] or Crohn’s) and hospital/surgeon factors (ex. hospital surgical volume, surgeon experience).