Pediatric systemic lupus erythematosus (pSLE) is a chronic, multisystem autoimmune disease characterized by immune dysregulation, autoantibody production, complement activation and inflammatory injury affecting multiple organs. Compared with adult-onset systemic lupus erythematosus, childhood-onset disease is generally associated with higher disease activity, more frequent major-organ involvement, greater exposure to glucocorticoids and immunosuppressive therapy and earlier accumulation of irreversible damage. This narrative review summarizes the major clinical, immunological and laboratory characteristics of pSLE and examines treatment strategies and indicators of therapeutic response. Renal, hematologic, mucocutaneous, musculoskeletal and neuropsychiatric manifestations are emphasized because they substantially influence prognosis and treatment selection. Current management generally combines hydroxychloroquine with glucocorticoids and organ-specific immunosuppressive therapy, including mycophenolate mofetil, cyclophosphamide, azathioprine, methotrexate and calcineurin inhibitors. Biologic therapy, particularly B-cell-directed treatment, may be considered in selected patients with persistent or refractory disease. Treatment response should be assessed using clinical activity, urinalysis and renal indices, complement levels, anti-double-stranded DNA antibodies, blood counts and validated disease activity measures rather than relying on a single biomarker. A treat-to-target strategy aims for remission or low disease activity while minimizing glucocorticoid exposure and treatment toxicity. Future research should focus on pediatric-specific biomarkers, molecular phenotyping, precision immunotherapy and prospective studies defining predictors of response and long-term organ protection.