The establishment of a pediatric trauma system is an exercise in regionalization. The first step in program development is the acquisition of data necessary to understand the region. What are its boundaries? How many children are injured each year? How many die? What facilities already exist for the care of these patients? Who controls EMS? Are any referral systems in place? Next, agreement must be reached among the participants regarding which patients will be transferred. Who will make the transfer decision? Will it be made in the field or in the hospital? Will a numerical scoring system be used, or accident descriptors, or both? How and by whom will patients be transported? What method of communication will be used to link the components of the system? The linchpin of effective trauma systems is public involvement, yet in most parts of the United States and Canada the public is unaware of the trauma problem, and the importance of trauma as the number one child health problem remains unrecognized. Since trauma is as much a societal problem as a medical one, the enthusiasm of individuals and public service organizations should be cultivated and a coalition formed to create a regional system. The educational, research, and prevention programs of a pediatric trauma center are not usually self-supporting, making progress in these areas dependent upon outside support. In several cities, grants and endowments have been received from service organizations, foundations, public-spirited companies, and individual philanthropy. Some assurance of a continuing source of funds usually is necessary before hospitals will accept part of the financial risk. The goal for a regional pediatric trauma system is to provide a new and better service for child accident victims. To succeed, the program must be carefully tailored to regional needs, be medically sound, well-organized, and have a solid fiscal base. Planning and commitment are the essential ingredients in pediatric trauma care.