PURPOSE OF REVIEW Injury is a leading cause of pediatric death and disability. Although adult trauma care in the United States has been celebrated as a model system of emergency care, it is not clear that pediatric trauma care is as well organized. We seek to describe in this review the current state of pediatric trauma care and suggest next steps required to ensure the efficient delivery of pediatric trauma care. RECENT FINDINGS Eighty-four percent of adults in the United States have access to a level 1 or 2 trauma center within an hour, and 71.5% of pediatric patients have access to a verified pediatric trauma center within an hour assuming ground and air transport. These results are variable depending on state, region, and population density. An estimated 17.4 million children do not have access to a pediatric trauma center within 60 min. SUMMARY Trauma centers improve outcome for injured patients with care at pediatric-focused centers superior to that provided at nonpediatric centers. However, access to high-level trauma care varies geographically and is not available to all children in a timely fashion. Future studies should correlate access to outcome and guide policy makers to optimize trauma systems for children.