While less common in the pediatric population, nephrolithiasis represents a burden for patients and their families, as well as an increasing financial burden for the health care system. Annual expenditures related to acute care for pediatric stone disease have been estimated to be around $375 million. Long-term preventive care, surveillance imaging, and medical treatment may further increase this cost. Unique considerations for the pediatric stone former impact the approach to care, as pediatric-specific risk factors contribute to stone disease, clinical presentation, and differences in medical, surgical, and preventive care. This chapter presents a comprehensive overview of the current literature focused on pediatric nephrolithiasis and provides comparisons to adult stone disease trends and management. The chapter also highlights areas of management where care for the pediatric patient may differ from adult care.