Kidney stone disease (nephrolithiasis), a disorder of mineral metabolism, results in recurring symptomatic events that account for billions of dollars in annual health care costs. Historically, nephrolithiasis affected older adult men but now is increasingly occurring earlier in life. Early-onset kidney stone disease has also increased among all Black youths, predominantly among Black females.1 The prevalence of nephrolithiasis in the United States increased from 5% (in 1988 to 1994) to 9% (in 2007 to 2010)2; among all age groups, the greatest increase in the annual incidence of nephrolithiasis is among adolescents. This earlier age at onset has increased the number of children presenting to the emergency department, admitted to the hospital, and requiring surgery, effects compounded by a 50% recurrence rate of symptomatic stone events within 5 years of diagnosis.3 The rapid emergence of nephrolithiasis as a disease of childhood has revealed deficiencies in our understanding of the epidemiology of the disease and exposed critical gaps in the evidence informing treatment decisions. This Viewpoint explores these deficiencies and proposes a framework to address these gaps in order to improve outcomes for this vulnerable population.