Play has always been an essential part of childhood, but it looks different for modern children, who increasingly engage in virtual play. More than 90% of children older than 2 years play video games, and three-quarters of American households own a video game console. Children 8 to 17 years of age spend an average of 1.5 to 2 hours daily playing video games. Recent developments framed by decades of research have provided insight into how games influence children’s physical health, mental health, social behaviors, and cognitive development. Anticipatory guidance surrounding media use is often centered on screen time, but pediatricians should have some knowledge of the unique benefits and risks associated with this nearly ubiquitous activity. In light of the recent addition of gaming disorder to the International Classification of Diseases, 11th Revision, this review includes a discussion of the epidemiology, clinical features, and diagnosis of gaming disorder, including the use of existing screening tools. As games become more popular while ever-increasing in scope and complexity, this review aims to educate the modern pediatric provider about what is known, what is uncertain, and how to use this knowledge in the management of both healthy and unhealthy video gaming in children.