A wide variety of the etiological considerations arise when evaluating children with pediatric cataracts. These considerations differ for unilateral and bilateral cataracts and could pose a challenge to both pediatric and comprehensive ophthalmologists. A rational approach to evaluation requires detailed history-taking and ocular and systemic evaluation followed by appropriate laboratory and genetic testing. Family history, specific morphological indications, and associated systemic features provide further clues. This video provides a step-wise approach to the evaluation and diagnosis of the ocular and systemic conditions of pediatric cataracts.