Hematuria can arise from any segment of the urinary tract. Common causes of gross hematuria in children include cystitis, pyelonephritis, irritation of the urethral meatus or perineum, and trauma. These conditions are readily diagnosed with lab and imaging tests. Cystoscopy is reserved for children with masses detected by imaging, bleeding due to traumatic injury, or chronic sterile cystitis. Asymptomatic microscopic hematuria can be a benign finding, provided that it is not associated with hypertension, proteinuria, elevated serum creatinine, abnormalities on renal ultrasound, or a family history of kidney disease. Microhematuria that is transient is benign. Persistent microscopic hematuria can be caused by glomerulonephritis, glomerular basement membrane disorders, pyelonephritis, hypercalciuria, nephrolithiasis, cystitis, urine withholding, and perineal irritation. Rational evaluation of hematuria is needed to direct children to the appropriate care.