Anterior shoulder instability in children and adolescents presents unique diagnostic and therapeutic challenges due to age-specific anatomical and physiological differences. While primary dislocations are rare in children under 12, adolescents (14–18 years) show recurrence rates comparable to high-risk young adults (up to 95%). Conservative treatment following a first dislocation may be appropriate in lower-risk groups; however, high recurrence in active adolescents often necessitates early surgical intervention. Risk factors for recurrence include male sex, age > 14, contact sports participation, closed humeral physis, and the presence of bony lesions (e.g., Hill-Sachs). Imaging modalities such as X-ray, MRI, and 3D CT play essential roles in assessment and treatment planning. Surgical options, including arthroscopic or open Latarjet procedures, demonstrate lower recurrence and better return-to-sport rates compared to conservative management. A third dislocation is considered a critical threshold, typically warranting operative management. Treatment decisions should be individualized based on age, activity level, and injury pattern. Further research is needed to optimize rehabilitation protocols and determine the role of early surgery in high-risk adolescents.