The subspecialty of pediatric emergency medicine has grown since children’s hospitals established training programs for the specialized care of critically ill and injured children in the 1980s and the subspecialty was recognized in 1992. Informal regional networks are available in many areas. In addition, the federally funded Pediatric Emergency Care Applied Research Network is developing evidence-based practices, and the Committee on Quality Transformation of the AAP Section on Emergency Medicine is implementing best practices on a broad scale.

Despite this growth, the quality of pediatric emergency care varies widely. Barriers to achieving optimal care for all children include misaligned incentives for payment; overcrowding; low-volume emergency departments (EDs) that are unprepared to treat children; poor adherence to best practices and clinical guidelines; lack of alternative resources for mental health and other subspecialty patients; and a lack of widely accepted performance metrics.

Because optimal care has not been defined in many areas,...

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