Injuries are the leading cause of death and disability among children and adolescents in the United States. Despite the importance of timely and specialized trauma care, only 54.5% of children live within 1 h of a designated pediatric trauma center (PTC). In contrast, 77.2% of the total US population resides within 1 h of an adult trauma center (ATC). Consequently, injured children are often treated at ATCs or hospitals without pediatric trauma qualifications. This chapter explores the disparities in access to pediatric trauma care and evaluates whether the benefits of PTCs outweigh the advantages of immediate care at ATCs. The literature has shown that children treated at PTCs compared to ATCs experience a 41% reduction in mortality along with reductions in the use of computed tomography and the operative management of blunt solid organ injuries. However, timely access to definitive care also has clear benefits in the literature. This chapter underscores the need for comprehensive pediatric trauma systems and state-level assessments. While PTCs provide superior outcomes, increasing the pediatric readiness of all trauma centers should be prioritized to ensure equitable access to high-quality trauma care for children.