Acute pediatric stroke is growing in incidence with the longer survivorship of children with medical complexities, yet detection and treatment of this disease continues to be met with limitations. It is essential for the frontline provider to appropriately identify various presentations of acute pediatric stroke for timely management to occur. Although studies in thrombolytic and endovascular recanalization therapies are limited, the safety and efficacy of these treatments continues to be explored. As pediatric tertiary care centers improve their stroke management, it is increasingly important to implement hospital protocols with a multifaceted approach. This article summarizes the issues and presentations behind identifying acute pediatric stroke, the research behind these emerging therapies in children, and the process of successfully applying pediatric stroke protocols. [Pediatr Ann. 2021;50(6):e242-e244.].