This practice point applies to children aged 90 days through 17 years who have typical, newly diagnosed primary immune thrombocytopenia (ITP). Current recommendations on management and information from recent studies are summarized with the goal of decreasing variable practice among providers and improving patient-centred care. Options for initially managing young patients with ITP who experience bruising, petechiae, or occasional mild epistaxis not interfering with daily living include observation without pharmacotherapy as a first-line option. When active therapy is pursued, choices include the use of corticosteroids and intravenous immunoglobulin. Children with moderate or severe bleeding continue to require hospitalization and treatment. Shared decision-making can enhance patient-centred care and ensure that the families have a full understanding of the management options available.