Pediatric bone lesions encompass a diverse spectrum of conditions, including benign neoplasms, cystic lesions, fibro-osseous lesions, and malignant tumors. This review highlights key diagnostic and management principles for commonly encountered non-sarcomatous lesions such as chondroblastoma, giant cell tumor, and aneurysmal bone cyst. Emphasis is placed on integrating clinical presentation, radiographic imaging, histopathological examination, and molecular diagnostics, such as H3.3 mutations and USP6 rearrangements, to refine differential diagnoses. A multidisciplinary approach is essential for optimizing outcomes in pediatric bone tumor care.