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Affective decision-making (ADM) as it is assessed through the Iowa gambling task (IGT) is an area of research for which growing studies have recently emerged within the pediatric setting, in relation to theoretical and clinical issues arising from this setting. In this context, various adaptations of the original IGT have been proposed on the basis of ergonomic and procedural changes to make the task easier to perform for children, in particular for those who are younger. The aim was also to manipulate some task parameters that might explain behavior such as the frequency and the magnitude of the losses. In the first part of this review, the main available adjustments of the IGT, which have been used with children together with the differences to the classic form of the task, are presented. Developmental studies based on these tools have highlighted both early and protracted improvement of ADM throughout childhood and adolescence, which has been partially linked to the behavior of brain-damaged adults. Moreover, the gradual emergence of ADM skills seems to be contingent upon a number of factors, such as gender or verbalization abilities, and is characterized by patterns of response that may be specific to childhood. These developmental and theoretical issues are summarized in the second part of this paper, which examines the relationship between ADM and cognitive aspects of executive function (known as “cold” executive processes). Although controversial, the predominant view based on several empirical findings is that ADM and cold executive function are relatively independent from one another over the course of development. This question will be extended in the last part of the review, according to the data reported in different clinical contexts for which an atypical development of ADM has been more or less clearly identified. If they are consistent with the hypothesis of a congenital or acquired impairment of the underlying frontal-subcortical networks, clinical manifestations associated with ADM deficit as well as their links with the dysexecutive features observed in children remain to be specified.