Tubo-ovarian abscesses (TOA) in children and adolescents may be missed or delayed in diagnosis due to differences in the etiologies, presentation, and clinical evaluation compared to adult patients. Management of TOA should include intravenous (IV) broad-spectrum antibiotics for all patients; additional abscess drainage through image-guided techniques may be co-initiated with antibiotics as first line treatment for those with risk factors for treatment failure, or reserved as second-line treatment for those who do not improve with IV antibiotics. Surgical interventions impose a higher risk of complications and are generally reserved for clinically unstable patients or for those who fail both IV antibiotics and image-guided abscess drainage. Selection of management must balance complication risk of the TOA itself with iatrogenic complication risks. This article reviews TOA in the pediatric and adolescent population, highlighting the different etiologies in younger patients compared to adults, and reviewing current recommendations for evaluation and management.