Instability in the pediatric elbow can be secondary to trauma, developmental disorders, congenital anomalies, inherited disorders, or acquired systemic processes. The pediatric elbow presents unique challenges with regard to open growth plates, propensity for dislocation and spontaneous reduction, and increased time for the development of post-traumatic deformity into adulthood. The purpose of this article is to review current concepts of injuries leading to elbow instability, discuss how to recognize and treat the instability, and address other, nontraumatic causes of elbow instability.