Background <p>Anorectal diseases in childhood are frequently misdiagnosed and treated.</p> Objective <p>To debunk the myth of anal thrombosis and hemorrhoids in pediatric patients.</p> Material and methods <p>A search and analysis of current available literature were carried out. Presentation of the first series of pediatric patients with perianal venous hyperplasia based on a&#xa0;retrospective data analysis. Evidence-based discussion of basic research and expert recommendations.</p> Results <p>The entities anal thrombosis and hemorrhoidal disease rarely occur in childhood, which can be well-explained by the etiology and pathogenesis; however, perianal venous hyperplasia is often diagnosed in pediatric patients. This is the first case series of 22&#xa0;children with perianal venous hyperplasia to be published. In this series all affected patients presented with a disorder of defecation, 78% suffered from a tendency to chronic constipation, 14% complained of pruritus ani and 1 child reported perianal pain.</p> Conclusion <p>The frequently and physiologically occurring perianal venous hyperplasia in childhood should not be misinterpreted as anal thrombosis. In the rare cases of pediatric hemorrhoidal disease, an underlying portal hypertension should be ruled out. Sclerotherapy of hemorrhoids should be avoided in childhood due to a&#xa0;lack of approval and reliable data. As there is still uncertainty in the diagnosis and in the choice of adequate treatment for acquired anorectal diseases in childhood, the establishment of generally applicable guidelines should urgently be addressed.</p>