Purpose <p>To investigate the current status of treatment, monitoring strategies, and variations in clinical decision-making for childhood Graves’ disease (GD) among Chinese children.</p> Methods <p>A self-designed questionnaire was distributed via an online platform to physicians from the Endocrine Genetic Metabolism Group of the Pediatric Branch of the Chinese Medical Association and the Western Pediatric Endocrine Genetic Metabolism Cooperative Group. The survey covered the acceptance of recommended initial methimazole (MMI) doses, as well as actual practices regarding initial dose selection, dosing frequency, monitoring parameters and frequency, and criteria for drug discontinuation.</p> Results <p>A total of 276 valid questionnaires were collected; 99.3% preferred MMI as first-line treatment. Physicians were stratified into high-volume (&gt; 20 cases, <i>n</i> = 70) and low-volume (≤ 20 cases, <i>n</i> = 206) groups based on the number of new GD cases treated per year. The high-volume group more frequently believed drug instructions and guideline-recommended initial doses required adjustment and selected higher initial doses (&gt; 0.3–0.5&#xa0;mg/kg/d), whereas the low-volume group predominantly chose 0.2–0.3&#xa0;mg/kg/d. While 44.9% preferred once-daily dosing, monitoring strategies varied. Primary discontinuation criteria included negative thyroid-stimulating hormone receptor antibodies, treatment duration, and reduction of thyroid volume. High-volume physicians favored longer treatment courses; the proportions of physicians assessing eligibility for discontinuation at &lt; 2 years and ≥ 2 years were 7.2% and 87.1%, respectively, compared to 28.2% and 66.0% in the low-volume group.</p> Conclusion <p>Heterogeneity exists in childhood GD management in China. High-volume physicians tend to adopt proactive individualized dosing and longer treatment durations. High-quality evidence is needed to standardize clinical practice.</p>