The main goal in managing metabolic syndrome (MS) in children and adolescents is to prevent Type 2 DM and reduce the risk of future cardiovascular disease. Although frustrating and challenging for both patients and healthcare providers, the best strategy for managing MS is preventing obesity through promotion of lifestyle modifications that include weight reduction, prevention of excessive weight gain and increase physical activity. Different therapeutic options and medications for MS are discussed including side effects of each drug. Medication for MS should be given to children and adolescents only after attempts at lifestyle modification have failed. Medications for MS should be closely monitored for their side effects on patients, and their application supervised only by caregivers familiar with their use.