The practice of upper gastrointestinal endoscopy in children continues to evolve. Therapeutic endoscopic procedures are now routinely performed in children. Patient preparation, sedation, and instrumentation have improved, allowing therapeutic endoscopy to be performed for a wide variety of conditions. This article focuses on the role of endoscopy in the diagnosis and care of caustic ingestion, balloon dilation of esophageal strictures, and new developments in the treatment of achalasia in children.