Pediatric differentiated thyroid cancer makes up approximately 10% of all thyroid malignancies and is the second most common cancer in adolescents aged 15–19. There should be a high index of suspicion of any thyroid nodule that present in childhood as malignancy rates can be as high as 25–50%. Most DTCs in children are well-differentiated tumors but present with a higher frequency of multifocality, nodal involvement, extrathyroidal extension, and distant metastases. Long-term survival is excellent but recurrence rates can approach 40–50% over 40–50 years. Treatment generally involves a total thyroidectomy; more extensive surgery and the use of radioiodine need to strike a balance between maintaining the low disease-specific mortality currently experienced by children with DTC and reducing potential complications from therapy that ensures a good quality of life during a very long survivorship. Risk stratification is similar to adults, but re-stratification based on response to therapy 1–2 years after treatment appears to be the most reliable at predicting future recurrence and dictating the level of surveillance. Future research should focus on long-term survivorship issues and validating risk stratification systems.