A large proportion of chronic hepatitis B virus (HBV) infections are acquired during childhood. Fewer chronic hepatitis C virus (HCV) infections occur in children than in adults, but thousands of children worldwide have this serious infection. Optimal treatment strategies for these chronic infections in children have not been determined, because data on the natural history are limited. Few medications are currently approved for use in this population. This article discusses how chronic viral hepatitis differs in children and adults in epidemiology, natural history, progression of disease, and response to treatment. Treatment options are discussed, including patient selection, specific medications, ongoing studies, and future treatment options.