Systemic lupus erythematosus (SLE) is more severe in children than in adults, and often needs aggressive treatment. Classical (old ) therapies include mostly non-steroid anti-inflammatory drugs, hydroxychloroquine, corticosterois and cyclophosphamide. However, these two latter drugs can induce severe side effects. Recently, new drugs, especially Mycophenolate Mofetyl and anti-CD20 antibody, have been proved to be efficient and well tolerated in adult-onset SLE and may become mainstay therapeutic option for severe chidhood-onset lupus manifestations. Management of complications such as growth failure, osteoporosis, premature atherosclerosis and anti-phospholipid syndrome has also progressed within the last years. Beside these promising perspectives of treatment, psychological support, long-term follow-up and program of transition from the pediatric to the adult care unit remain essential.