Approaches to the management of portal hypertension (PHT) and variceal hemorrhage in pediatrics remain controversial, in large part, because they are not well informed by rigorous clinical studies. Fundamental biological and clinical differences preclude automatic application of approaches used for adults to children. On April 11-12, 2015 experts in the field convened at the first Baveno Pediatric Satellite Meeting to discuss and explore current available evidence regarding indications for MesoRex Bypass (MRB) in extrahepatic portal vein obstruction (EHPVO) and the role of primary prophylaxis of variceal hemorrhage in children. Consensus was reached regarding MRB. The vast majority of children with EHPVO will experience complications that can be prevented by successful MRB surgery. Therefore, children with EHPVO should be offered MRB for primary and secondary prophylaxis of variceal bleeding and other complications, if appropriate surgical expertise is available, if pre- and intra-operative evaluation demonstrates favorable anatomy, and if appropriate multi-disciplinary care is available for post-operative evaluation and management of shunt thrombosis or stenosis. In contrast consensus was not achieved regarding primary prophylaxis of varices. Although variceal hemorrhage is a concerning complication of PHT in children, the first bleed appears to be only rarely fatal and the associated morbidity has not been well characterized. There are few pediatric data to indicate the efficacy and safety of pharmacologic or endoscopic therapies as primary prophylaxis, or that prevention of a sentinel variceal bleed will ultimately improve survival. Therefore, no recommendation for primary prophylaxis with endoscopic variceal ligation, sclerotherapy, or nonspecific beta-blockade in children was proposed. This article is protected by copyright. All rights reserved.