The study analyzed the global burden of pruritus in children and adolescents under 20 years of age from 1990 to 2021, based on the Global Burden of Disease Study 2021 database. In 2021, 14,899,940 children and adolescents suffered from pruritus, including 12,124,677 new cases. The age-standardized incidence rate (ASIR) reached 458.02 per 100,000 inhabitants. Higher values of ASIR (510.85 vs. 408.33), ASPR (625.2 vs. 498.12) and ASDR (6.79 vs. 5.42) were found in girls and women compared to boys and men. Burden increased with age from <5 years (ASIR 411.47) to 15–19 years (ASIR 526.3). Regions with a low sociodemographic index (SDI) had the highest rates: ASIR 493.99, ASPR 614.24 and ASDR 6.66; the most affected were East, South and West Sub-Saharan Africa and the United Republic of Tanzania, the lowest was Germany. The global annual percentage change (EAPC) showed an increase of 0.32% in ASIR, 0.35% in ASPR and 0.36% in ASDR; fastest growing ASIR in East Asia, ASPR and ASDR in Australia and the Netherlands. The total burden of itching has increased significantly and is predicted to increase further until 2045.