This chapter discusses the systemic and global issues associated with pediatric trauma care, particularly in low- and middle-income countries (LMICs) like India, where more than 95% of childhood injury-related deaths occur. The challenges of managing pediatric trauma include inadequate infrastructure, lack of pediatric-specific trauma training, resource limitations, and delayed access to definitive care, all of which contribute to disproportionately high mortality and long-term disability rates in children. The chapter examines historical perspectives of pediatric trauma systems, tracing back to the pioneering work of figures such as Catherine Jane Wood and key policy milestones like the Platt Report and the EACH Charter. The trauma care systems for children are developed from adult-centric models to dedicated pediatric trauma centers and family-centered care approaches. The chapter compares the trauma systems in high-income countries with those in LMICs, where children are frequently managed as “small adults,” neglecting their unique physiological and emotional needs. The chapter also highlights the role of critical policy frameworks and organizational roles—such as those of the World Health Organization (WHO), the Pediatric Trauma Society, and the National Pediatric Readiness Project. The modern innovations including simulation-based training for primary care providers (PCPs), telemedicine support in underserved areas, and the growing role of artificial intelligence (AI) in diagnostics, triage, and patient engagement have also been discussed. The chapter examines the psychological burden on pediatric trauma workers who frequently feel the burnout, secondary traumatic stress, and moral distress. To bridge current gaps, the chapter presents a set of strategic recommendations at both national and global levels, advocating for standardized pediatric trauma protocols, investments in capacity building, data systems, community education, and ethical integration of emerging technologies. A multipronged, collaborative, and innovation-driven approach is essential to reform pediatric trauma care globally.