Pediatric retinal detachment is an uncommon and challenging disease; it differs from adult detachments in etiology, anatomic characteristics, management, and prognosis. The anatomic success, when achieved is frequently not related to functional recovery. To operate, the pediatric vitreoretinal surgeon must understand the characteristics that define diseases, such as retinopathy of prematurity (ROP), familial exudative vitreoretinopathy (FEVR), persistent fetal vasculature syndrome (PFVS), congenital x-linked retinoschisis (CXLRS) and Coats disease. Here we discuss key features of the surgical approach to complicated pediatric retinal detachments.