To assess emergency nurses' levels of preparation and education regarding pediatric patients, their levels of knowledge and comfort with specific medical conditions of these patients, and the need they perceive for special policies for pediatric patients. Surveys were mailed to nurse managers and emergency nurses in six diverse counties, including Los Angeles and vicinity. Fifty-one nurse managers and 362 emergency nurses from 51 hospitals responded to the questionnaires. More than half of the emergency nurses had 6 or more years of experience; many had certificates, professional designations, and pediatric nursing education. Those with more pediatric education and those designated Pediatric Advanced Life Support, Certified Emergency Nurse, and Mobile Intensive Care Nurse reported the greatest comfort and knowledge with pediatric patients. The greatest discomfort and least knowledge were associated with neonatal emergencies, major trauma, child abuse or sexual abuse, sudden infant death syndrome, envenomation, psychiatric emergencies, meningococcemia, near-drowning, respiratory arrest, and cardiac arrest. Opinions regarding the need for special pediatric policies differed in some cases from current practice. Pediatric medical conditions associated with high nurse discomfort and low knowledge point to areas of need for specific education.