Pediatric bipolar disorder (PBD) is a serious condition, and a substantive need exists for evidence-based treatments for children and adolescents suffering from this condition. A fundamental intervention used in this patient population is pharmacotherapy. Despite the importance of medication treatment in this patient population, only limited amounts of methodologically stringent data exist pertaining to this form of intervention. The evidence that does exist suggests that some psychotropic medications can provide salutary effects for youths suffering from bipolar I disorder (BD-I). Also relevant is the pharmacotherapy of genetically at-risk children suffering from bipolar spectrum disorder and treatment of psychiatric comorbidities. Further placebo-controlled trials are needed in order to better characterize the efficacy and safety of psychotropic medications in this population.