The clinical challenges of diagnosing and managing pediatric and adolescent catatonia will be addressed in this talk. Catatonia is being recognized more frequently, yet timely and consistent diagnosis and treatment remain a challenge. Many training programs in psychiatry, neurology and pediatrics provide limited education on recognition and assessment of catatonia and its specific associated neurological symptoms. Assessment for catatonia is often delayed due to diagnostic overshadowing, particularly in neurodevelopmentally disordered patients or those with known psychotic or severe mood disorders. This delay has implications for treatment course and prognosis. Adequate treatment often requires use of much higher doses of benzodiazepines than most prescribers find comfortable, and it may require ECT which is not universally available for children and adolescents.