* Abbreviations: ISSOP — : International Society for Social Pediatrics and Child Health UN — : United Nations Similar to previous reports,1–12 the latest annual United Nations (UN) Report on Children and Armed Conflict identified 10 173 child casualties and 4019 children killed in armed conflicts the preceding year.6 Most of these children were victims of “internationalized” conflicts, defined as internal conflicts in which ≥1 third party governments are involved with combat personnel.13 Five such protracted conflicts involve the United States and allied armies (Afghanistan, Syria, Yemen, Somalia, and Mali). These account for 69% of total reported child casualties and 64% of children killed. We present examples of how children continue to be harmed in armed conflicts as well as practical suggestions for how pediatricians can help reduce the impact of armed conflicts on children. Children are inadvertently harmed in conflicts. However, many civilians, including children, are injured or killed because of policies and compromises made by military operation planners. For example, the Islamic State of Iraq and Syria used civilians as human shields in urban areas. To expedite the operation to eliminate the Islamic State of Iraq and Syria in Iraq and Syria while limiting US ground troops, US government policy makers increased the “non-combatant casualty value,” the number of civilians allowed to be killed per air strike.14 By 2018 at least 1139 civilians, including children, were killed in that operation over a 4-year period; many died as … Address correspondence to Tom Adamkiewicz, MD, FRCP(C), MSCR, Perimeter Pediatrics, 3020 Mercer University Dr, Atlanta, GA 30341. E-mail: tadamkiewicz{at}msm.edu