Affecting approximately 2% of children and adolescents, trichotillomania is a psychiatric disorder marked by recurrent, compulsive hair pulling that often goes undiagnosed. Despite its profound psychosocial, functional, and medical consequences, it remains under-recognized in pediatric populations. This review focuses on current knowledge of the etiology, clinical presentation, and management of pediatric trichotillomania, emphasizing its frequent psychiatric comorbidities and severe impact on quality of life. Current evidence suggests that early multidisciplinary intervention is essential to mitigate the disorder’s negative impact on child development and functioning. While behavioral therapies, particularly habit reversal training, show promise, pharmacological options lack consistent support in younger patients. Further research is needed to develop evidence-based, age-appropriate treatment strategies.