Twenty years from now, the use of refractive surgery to treat pediatric conditions will have been shown to be either a great advance, a sometimes useful tool, or a serious mistake for young patients with refractive errors. It falls on ophthalmologists practicing in the early part of the 21st century to determine how to best serve, as well as protect patients while navigating through those years. The aim of this chapter is to analyze refractive surgery techniques in light of current understanding of the anatomy and physiology of the growing pediatric eye, to learn from the lessons already reported for the various techniques, and to discuss both the potential benefits and possible pitfalls of using refractive surgery for a variety of indications in pediatric ophthalmology.