The child presenting with abnormal pubertal development elicits great parental concern and presents a diagnostic challenge to the managing pediatrician. The appropriate workup of children with disorders of pubertal development relies heavily on the synthesis of history, physical examination, pertinent laboratory tests, and medical imaging. This review addresses female and male disturbances in pubertal development and includes isosexual and heterosexual precocious puberty and delayed development. Discussion is focussed on the tailored algorithmic approach to imaging; integrating clinical and laboratory information. Bone-age determination, ultrasonography, and MRI are emphasized as they relate to this complex and challenging clinical problem.