Endoscopic cholangiopancreatography (ERCP) is an established diagnostic and therapeutic tool for the gastroenterologist. Its use in children, however, is still limited and it may be underutilized. Several factors may account for this, such as the perceived rarity of biliary and pancreatic disease in children, a lack of familiarity with ERCP by pediatricians and a lack of formal ERCP training for the pediatric gastroenterologist. Such factors notwithstanding, the number of both diagnostic and therapeutic ERCPs performed in children has grown significantly in recent years. For example, ERCP is now being used in establishing the diagnosis of infantile cholestasis. Therapeutic ERCP, such as biliary stone removal, is the most rapidly growing area of pediatric ERCP. This article reviews the role of ERCP in pediatric patients, illustrates new developments, and emphasizes technical considerations in children.