Summary: Primary immune thrombocytopenia (ITP) in childhood is self- -limiting disease, usually with a short and mild disease trait. In some patients treatment is necessary due to an increased risk of bleeding or a significant reduction in quality of life. Conventional therapy of ITP includes glucorticosteroids and intravenous immunoglobulins. Despite their widespread use, some patients fail to achieve sustained remission. In cases of relapsed, chronic, or multidrug-resistant disease, second- -line treatment is implemented, including thrombopoietin receptor agonists, rituximab, mycophenolate mofetil, and other modern immunosupressive drugs. In parallel, intensive research is underway on new therapeutic molecules that act through distinct immunomodulatory mechanisms at cellular level, offering the prospect of expanding therapeutic options for ITP. Splenectomy remains the least frequently used treatment option for ITP. It has been proved that combined treatment strategies, using new drug categories in an early clinical phase of ITP, can improve the chance for complete and persistent remission. Therapy is individualized not only on the drugs availability basis. Current treatment decisions in childhood ITP are based on clinical activity of thrombocytopenia, quality of life and patients expectations regarding therapy itself.