Introduction and objective: In recent years, there has been an increase in the incidence of cholelithiasis in the paediatric population. Most patients have an asymptomatic course of the disease; however, some children may experience serious complications. The aim of this study was to analyse the clinical features, risk factors, and complications in paediatric patients diagnosed with cholelithiasis. Materials and methods: A retrospective analysis was conducted on 106 patients, including 59 girls and 47 boys aged 2 months to 17 years, diagnosed with cholelithiasis between 2013 and 2022. Results: The study group was stratified into five subgroups based on clinical diagnoses: asymptomatic cholecystolithiasis, symptomatic cholecystolithiasis, complicated cholecystolithiasis, choledocholithiasis with cholestasis, and choledocholithiasis with acute pancreatitis. Younger children exhibited a higher prevalence of asymptomatic cholecystolithiasis compared to older patients. The predominant clinical symptoms included abdominal pain, vomiting, and jaundice. A significant prevalence of overweight and obesity was noted. In 36.6% of patients diagnosed with choledocholithiasis, gallstones were visualised on cholangio-MRI despite normal findings on ultrasound examination. The most common complications were cholecystitis, acute pancreatitis, and cholangitis. The primary risk factors identified in the study population were comorbidities, excessive nutritional status, and a positive family history of cholelithiasis. Additionally, a significant group of children using psychiatric medications was identified. Conclusions: An increasing incidence of cholelithiasis is observed in the paediatric population, also in the youngest age groups. Co-occurring diseases, medications, and obesity undoubtedly play a role. The use of psychiatric medications should be considered as a possible risk factor for cholelithiasis in children.