Portal hypertension (PH) is caused by increased portal blood flow/increased resistance to portal blood flow, leading to a state of hyperdynamic circulation. The causes of portal hypertension in children are different from the adults. In children, extrahepatic portal venous obstruction predominates the list as compared to liver cirrhosis in adults; thus, children predominantly have noncirrhotic portal hypertension. Acute variceal hemorrhage is commonly self-limiting but has high morbidity and is a frightening event. Portal hypertension may cause massive splenomegaly in children, and they present with hypersplenism. There is a lack of robust data and guidelines on the management of pediatric portal hypertension. Medical and endoscopic management has a high success rate in the control of variceal bleeding. Cases with refractory variceal bleeding and massive symptomatic hypersplenism with splenomegaly are candidates for surgical intervention. Several porto-systemic shunt operations and some non-shunt operations are in practice over various centres. Patients with poor hepatic function are candidates for liver transplantation.