Early treatment of class II malocclusion has been the subject of debate in orthodontics for many years. In particular, the decision to undertake a two-phase approach by starting treatment in the early mixed dentition; or alternatively, taking a single-phase approach and starting treatment as the patient is establishing the permanent dentition - ideally, timing treatment to coincide with the pubertal growth spurt. These treatment decisions have been the subject of several large-scale randomised clinical trials and systematic reviews and there is a large evidence base. This lecture will give an overview of the current evidence relating to these treatment philosophies and provide clinical examples. We will review the evidence relating to clinical outcomes for patients, skeletal growth and the association between increased overjet and risk of trauma to the maxillary incisor teeth in children and adolescents. We will provide guidance in case selection for different management strategies and try to provide a balanced philosophy for the management of class II malocclusion in the child population.