Femoral shaft fractures in children are common injuries requiring orthopaedic intervention. Options for management have expanded in the past several decades to include an array of surgical and nonsurgical intervention. The American Academy of Orthopaedic Surgeons has produced practice guidelines for this injury to guide appropriate management. The age of the patient, the stability of the fracture, and the energy of the injury are factors when deciding the appropriate treatment for a patient. Orthopaedic surgeons should be familiar with the history of the management of pediatric femoral shaft fractures and understand the options available now.