Key PointsQuestionWhat risk and protective factors are associated with delayed or missed pediatric preventive care in the US due to the COVID-19 pandemic by racial and ethnic group?FindingsIn this cross-sectional study using data from 50 892 respondents to the 2021 National Survey of Children’s Health, 27.6% of children had delayed or missed preventive care due to the COVID-19 pandemic. Predisposing, enabling, and need factors associated with delayed or missed preventive care differed by racial and ethnic group.MeaningThese findings highlight factors that may guide the design of targeted interventions to enhance timely pediatric preventive care among different racial and ethnic groups.