Bipolar disorder in children and adolescent is a chronic condition with poorer prognosis than the adults. So, early treatment strategies and rehabilitation programs are so important for juvenile with bipolar disorder. But the clinicians are faced with many challenging subjects in treatment programs. Anticipating these challenges may be helpful in programming better treatment strategies with fewer obstacles. Accordingly, the literatures about treatment challenges during past decade were reviewed. Base on these studies the most frequent challenges were higher frequency of comorbid disorders, longer duration of treatment, more needs for combination therapy, and limitation in prescription for some drugs because of their side effects and poor evidences in literature. Planning for non pharmacological interventions is the other challenging subject which should be considered in treatment programs.