Ghrelin is a 28 amino-acid brain-gut peptide that is well-known for its orexigenic and metabolic effects leading to an overall positive energy balance. It stimulates appetite and growth hormone release via the GHS-R1a receptors. GOAT has been identified as the enzyme that acylates ghrelin, which is important for its endocrine function. The ghrelin/GHS-R/GOAT system has been studied extensively in view of its association with several endocrine diseases and the potential of developing an effective treatment. These include obesity, Prader-Willi syndrome, anorexia nervosa and diabetes mellitus. Ghrelin system has also been associated with growth and stature. All these conditions can affect children and have a significant impact on the quality of health and life prognosis. In this review, we look into the association of ghrelin with appetite, growth and metabolic disorders in children.