Multiple sclerosis (MS) is being increasingly diagnosed in children and adolescents. Clinical and magnetic resonance imaging (MRI) features of MS in the pediatric population are similar to adult-onset disease, with some important distinctions. Case vignettes, recently published clinical definitions, and an approach to disorders considered in the differential diagnoses are provided in this article. Immunomodulatory therapies approved for use in adults with MS are safe and well-tolerated in children, although monitoring of liver function is of particular importance. Finally, this article presents recent research studies performed in an MS population for whom disease onset occurs in unique temporal proximity to the events involved in MS pathogenesis.