ILD may be underestimated due to its low incidence and lack of knowledge even though it is considered an orphan disease. The systemic inflammatory diseases with the highest likelihood of ILD are juvenile idiopathic arthritis, juvenile dermatomyositis, systemic sclerosis and juvenile systemic lupus erythematosus. In this review, we will look at the extent of ILD in the various rheumatological conditions affecting children, with an emphasis on early detection, escalation of therapy and continued monitoring of progress.