Pediatric venous thromboembolism (VTE) has seen a significant rise in prevalence coinciding with the increasing availability of complex and invasive treatments in children. While anticoagulation remains the cornerstone of VTE treatment, increasing evidence supports interventional approaches for select cases, particularly in life- or limb-threatening scenarios. Treatment strategies must be individualized, considering age-related differences in hemostasis and the higher bleeding risk associated with interventions. This remains challenging due to a dearth of pediatric-specific studies. This manuscript explores pathophysiology, risk factors, and management strategies for pediatric VTE, emphasizing both pharmacologic and interventional treatments and providing updated recommendations regarding available anticoagulant agents and VTE management paradigms in children. It highlights the potential of interventional techniques in special conditions, namely Paget–Schroetter syndrome, superior vena cava syndrome, inferior vena cava atresia, pulmonary emboli, and May–Thurner syndrome. In the absence of rigorous clinical trial data, continued multidisciplinary collaboration and standardized approaches will remain imperative for ensuring careful use of interventional procedures to achieve optimal outcomes in these young patients.