While the clinical presentation may vary greatly among patients, all pediatric inguinal hernias require operative treatment. Accurate diagnosis, recognition of alarming signs or symptoms, and the timing of surgical referral and operative repair are crucial in preventing the potentially severe complications of incarcerated inguinal hernias. In this chapter, we will review the presentation of inguinal hernias in the pediatric population and common conditions that can mimic hernias in children. We will describe the principles of clinical assessment and how this informs the timing of surgical referral and management. We will also briefly discuss surgical management of inguinal hernias to provide clinicians with general information and expectations for patients and families prior to their surgical appoint ment.