Pharmacy assessment of pediatric patients is similar in many ways to that of adults; however, there are many specific nuances that need to be considered in addition to the typical components of an adult assessment. There is a lack of pediatric-specific medication research and a much higher rate of “off label” medication use, so children are at higher risk of medication errors and related harm. Pharmacokinetic differences and other age-related differences result in highly variable dosing and responses to medications throughout childhood. Pharmacists need to be aware of this variability and use every patient encounter as an opportunity for (re)assessment of medication use, including dose, formulation, administration, and indication. Infants and children also have physiological differences from each other and from adults. These need to be considered when assessing efficacy, toxicity, and the patient’s overall response to medications through physical exam or use of laboratory values. Lastly, a lack of appropriate medication formulations for children creates a requirement for pharmacists to specifically assess the formulations, dose measurement, and administration of pediatric medications. This chapter provides an approach to pediatric assessment, highlights common sources of error, and provides strategies for managing pediatric medications.