Pediatric percutaneous nephrolithotomy (PCNL) for large stone burden is an under-utilized approach to stone removal in younger patients. This stems from the large instrumentation traditionally used interchangeably in adult and pediatric populations. However, recent efforts to "miniaturize" the approach, and therefore the associated morbidities, have made PCNL more amenable in the pediatric patient. Through the case of a 10-month-old female presenting with painless hematuria and a 10-year-old female with left flank pain and hematuria, both secondary to renal calculi, we present an overview of the challenges inherent to PCNL, the push for miniaturization, and examples of the preferred technique employed by fellowship trained pediatric urologists at our institution. In demonstrating this technique that is currently actively evolving, we hope to shed some light on the exciting new trend in "miniaturized" PCNL and its applicability - in regards to efficacy and safety - in the pediatric population.