Whole blood is becoming increasingly available as clinical experience broadens and safety studies continue to support its use. Whole blood administration in pediatric patients has been utilized for craniofacial, congenital cardiac, and complex spine surgeries, in trauma resuscitation, medical hemorrhage, and severe anemia. Its use in children is currently limited to type-specific and low titer type O whole blood (LTOWB). The criteria for LTOWB in children are usually limited by patient age and weight, along with cutoffs for the maximum quantity allowed per resuscitation. Cited advantages include improved transfusion efficiency, more concentrated cellular components and coagulation factors, less anticoagulant, reduced donor exposure, and a likely survival benefit. Thus far, studies examining type O whole blood administration in patients with non-type O blood have not found clinically significant evidence of hemolysis.