Key PointsQuestionWhat is the state of pediatric readiness in US emergency departments (EDs) during the COVID-19 pandemic?FindingsIn this survey study using a web-based assessment of leadership of 5150 EDs, 3647 (70.8%) responded, with a median weighted pediatric readiness score of 69.5 of 100. The presence of pediatric emergency care coordinators (PECCs), quality improvement plans, and board-certified emergency medicine or pediatric emergency medicine physicians were associated with better pediatric readiness; additionally, improvements have occurred in multiple domains since 2013 despite a reduction in the proportion of PECCs.MeaningThese findings suggest that pediatric readiness of US EDs was affected by the COVID-19 pandemic, yet engagement in these efforts remains strong.