Mucosal healing is the main treatment goal in the management of pediatric inflammatory bowel diseases (IBD), and accurate endoscopic assessment is essential for evaluating disease severity, monitoring progression, and assessing therapeutic responses. However, the wide variability of mucosal lesions, combined with the lack of standardized guidelines and limited training opportunities, complicates the scoring process and contributes to discrepancies in scoring accuracy. To address these issues, a panel of Italian pediatric endoscopists with expertise in IBD, convened by the Italian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (SIGENP), developed practical recommendations for assessing endoscopic lesions and applying endoscopic scoring systems in pediatric IBD. These guidelines, based on a review of current literature and expert consensus, aim to improve the consistency, reliability, and accuracy of endoscopic evaluations in children with IBD. By providing clear recommendations, the guidelines seek to enhance the reliability of scoring systems, ultimately supporting more effective disease management and treatment outcomes for pediatric patients.