80% of children are seen in non-Pediatric Emergency Departments (EDs). In a disaster, most children and their caregivers will go to the closest or their regularly identified ED for treatment. In disasters, the preservation of the Pediatric Tertiary Infrastructure for the sickest and most injured children is critical. Surge capacity for pediatrics may involve both ante-grade and retrograde distribution of pediatric patients and health care staff to preserve Tertiary capacity. Reverse Triage of stable pediatric patients to other hospitals with adapted units and staff can decompress tertiary facilities. General hospitals can allow an expanded care for pediatric patients. Surge capacity needs to be addressed to allow non-pediatric facilities to surge for pediatric patients. Disaster Credentialing by immediate cross-credentialing of appropriate health care staff needs to be reciprocal and internet based to allow appropriate staff to attend pediatric patients. Pediatric consultants can augment healthcare staff to allow input into expanded care roles. Pre-hospital providers should have more pediatric training. Rotated regional caches of pediatric equipment would expedite safe pediatric disaster site care and pre-hospital transportation to definitive care. Pediatric patients should routinely be included in disaster drills and in all-inclusive disaster plans, rather than in separate drills and plans. Pediatric patients are usually accompanied by caregivers who may need care as well. Secure tracking and reunification of unaccompanied minors needs to be addressed to allow tracking across jurisdictional boundaries. Limited access to data on children, and credentialing of shelter staff would preclude access by anyone without a specific need to know. There are no clear uniform liability statutes for care in declared disasters as well as no uniform agreements for reimbursement for medical care. These issues are an important facet of disaster care that still needs to be addressed.