There are approximately 25 million emergency department visits by children each year in the United States. It can be challenging for healthcare providers to maintain the readiness of emergency departments in terms of equipment availability, policies and procedures for the care of children, and quality improvement for pediatric patients. Nearly 90% of children are seen in general emergency departments, and 50% of emergency departments see fewer than 10 pediatric patients per day, resulting in somewhat limited experience with critically ill and injured children for most emergency care clinicians. In the framework of the current healthcare system that is wrought with overcrowding, underfunding, and highly variable pediatric capabilities, children are arguably at the greatest risk for medical error. This issue reviews the current state of pediatric readiness in emergency departments, the necessary steps to ensure day-to-day readiness, the published guidelines for pediatric readiness, and systems-based innovations in pediatric readiness.