Summary: Small intestinal bacterial overgrowth (SIBO) is a clinical condition characterized by excessive bacterial colonization of the small intestine, leading to impaired digestion, malabsorption, and nonspecific gastrointestinal symptoms. In the pediatric population, SIBO remains a significant diagnostic and therapeutic challenge, mainly due to the lack of well-defined diagnostic criteria and limited high-quality evidence. The prevalence of SIBO in children is not clearly established and varies depending on the studied population and diagnostic methods used. In the general pediatric population, SIBO appears to be uncommon, whereas higher rates of positive test results are reported among children referred for chronic gastrointestinal symptoms and in high-risk groups. Particular caution is required when interpreting diagnostic test results in children with functional gastrointestinal disorders, as positive indirect tests do not necessarily indicate clinically relevant bacterial overgrowth. Diagnosis of SIBO in children relies primarily on hydrogen and methane breath tests using glucose or lactulose. However, these tests have important limitations, including a substantial risk of false-positive results. The absence of standardized pediatric diagnostic thresholds further complicates clinical decision-making. Management of SIBO in children should be individualized and focused on identifying and addressing underlying predisposing factors. Although antibiotic therapy may lead to temporary symptom improvement in selected patients, it should not be used routinely or without careful clinical consideration. Avoiding overdiagnosis and overtreatment is essential to prevent unnecessary interventions and potential adverse effects in the pediatric population.