Artificial rearing of young animals represents a challenge in modern ruminant production systems. This work aims to evaluate the short- and long-term effects of the type of rearing on the animal’s health, growth, feed utilization and carcass performance. A total of 24 pregnant ewes carrying triplets were used. Within each triplet set, lambs were randomly allocated to one experimental treatment: natural rearing on the ewe (NN); ewe colostrum for 24 h followed by artificial rearing with milk replacer (NA) and 50 g of colostrum alternative supplementation followed by artificial rearing (AA). Milk replacer, ryegrass hay and creep feed were offered ad libitum, and each experimental group was kept in independent pens until weaning at 45 days of age. After weaning all lambs were placed together on the same pasture for fattening for 4 months. Blood samples were taken at 24 h after birth, at weaning and at the end of the fattening period (23 weeks). Results showed that no failure in the passive immune transfer was detected across treatments. Although artificially reared lambs at weaning had lower plasma levels of β-hydroxy-butyrate (−62%), high-density lipoproteins (−13%) and amylase (−25%), and higher levels of low-density lipoproteins (+38%) and alkaline phosphatase (+30%), these differences disappeared during the fattening period. Only the greater levels of calcium and the lower levels of haemoglobin and white blood cells detected at weaning in artificially reared lambs (+7.2%, −2.8% and −17.8%) persisted by the end of the fattening period (+4.3%, −3.3% and −9.5%, respectively). Minor diarrheal events from weeks 2 to 5 were recorded with artificial rearing, leading to lower growth rates during the 1st month. However, these artificially reared lambs caught up towards the end of the milk feeding period and reached similar weaning weights to NN lambs. During the fattening period NN lambs had a greater growth rate (+16%) possibly as a result of their greater early rumen development, which allowed a higher feed digestibility during the fattening period in comparison to NA lambs (+5.9%). As a result, NN lambs had heavier final BWs (+7.0%), but tended to have lower dressing percentage (−5.7%) than artificially reared lambs, thus no differences were noted in either carcass weight or in carcass conformation across treatments. In conclusion, the use of a colostrum alternative and milk replacer facilitated the successful rearing of lambs, reaching similar productive parameters; however, special care must be taken to maximize the rumen development before weaning.