Sinus thrombosis in children is increasingly recognized; however, the diagnosis is still frequently missed. Children may have an increased incidence of this disorder compared with adults, and neonates are at greatly increased risk compared with older children. Childhood CSVT carries significant long-term sequelae that include death or neurologic deficits in nearly 50% of cases. Neonates are not spared from these sequelae. At present, the approach to treatment is empiric but in the past decade treatment with anti-coagulants is supported by the unacceptable rates of adverse outcomes, the pathophysiology of CSVT, and the data supporting the efficacy and safety of anti-coagulation for adult CSVT. Among the most significant current and future developments in childhood CSVT is the evolution of accurate, noninvasive and economical neuroimaging techniques. The latter techniques have the potential to increase the detection rate of childhood CSVT, improve our understanding of the pathophysiology and define important subgroups of patients who best respond to treatment. An international interest in childhood CSVT is developing and, in the next decade, will enable the necessary multi-national clinical trials to provide evidence-based treatments and decrease the adverse outcomes.