Once considered rare in children, pediatric bipolar disorder is now widely diagnosed in the United States. The illness has become a cultural phenomenon, adorning the cover of Time magazine and headlining national news broadcasts. Kowatch and colleagues, in compiling consensus recommendations for bipolar disorder in children and adolescents, have done a laudable job given that the topic is infused with considerable controversy, debate, and dyspepsia. However, lost in the discussion is the fact that characterizing bipolar disorder as frequent, brief, intense outbursts of mood and behavioral dysregulation represents a fundamental change in the definition of the illness. This article discusses bipolar disorder and contains the following sections: (1) Diagnostic Continuity; (2) Specificity of Diagnostic Criteria; (3) Treatment Implications; and (4) Preschoolers.