Pediatric narcolepsy can be challenging to diagnose and manage given a broad range of co-morbidities only recently described in the literature. These co-morbidities are broad in scope and span medical, psychiatric, and sleep disorders. Such associated conditions highlight potential novel effects of hypocretin deficiency on metabolic and neural functioning. Clinically, medication treatments for narcolepsy have the potential to alter co-morbid symptoms for better or worse and may guide individual treatment plans. Furthermore, sleep physicians may need to ally with other health care providers in endocrinology and psychiatry to optimize the care of pediatric patients with narcolepsy.