BACKGROUND/AIM: The incidence and characteristics of pediatric thrombotic events have become increasingly recognized, due to the enhanced utilization of advanced diagnostic techniques. Pediatric thrombosis remains less frequent than in adults, often manifesting in those with underlying congenital or acquired risk factors. This study aimed to establish epidemiological data on pediatric thrombotic events in Bihor County, Romania, highlighting the challenges of diagnosis in smaller medical centers and proposing a relevant diagnostic and treatment algorithm. PATIENTS AND METHODS: This retrospective study, conducted over 22 years at the Emergency County Clinical Hospital Bihor, identified 39 pediatric patients diagnosed with thrombotic events using electronic medical records. RESULTS: Most patients (82.1%) were diagnosed between 2013 and 2024, with a slight male predominance. The age distribution shows two peak clusters: newborns up to one year and adolescents. The majority of cases (53.8%) were venous thromboembolism, followed by arterial thromboembolism at 41%, while 5.1% involved both types. Cerebral thrombosis was the most common, followed by lower and upper limb events. Inherited thrombophilia factors were found in all patients tested, with antithrombin, protein S, and protein C deficiencies identified. Malignancy was the most frequently acquired risk factor, and PAI-1 4G/5G was the most common genetic variant detected among inherited factors. CONCLUSION: This study highlights the significant rise in pediatric thromboembolism recognition over the past two decades; however, underdiagnosis remains an issue. Improved awareness among healthcare professionals is crucial, particularly for unprovoked thrombosis cases where a thorough thrombophilia panel and the involvement of a multidisciplinary team may be necessary.