Open surgical release is a safe and effective treatment option for the pediatric trigger thumb refractory to stretching. This technique video details set-up, surgical procedure, and post-operative care. A 1cm incision within the distal palmodigital crease exposes the flexor tendon sheath. The A1 pulley is divided, followed by additional division of the Annular Variable portion of the A2 pulley. This minimizes persistent or "recurrent" triggering and has been shown not to cause bowstringing. The radial digital nerve is visualized and protected. The incision is sealed and early range of motion encouraged. With complete release, triggering does not recur.