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This article is written based on the experiences from the Children’s Hospital of Eastern Ontario in Ottawa. Pediatric hospitals tend to be more equipment intensive than their adult counterparts; to further complicate the situation, manufacturers often do not pursue the development of equipment for this specialized market because of the high cost of Research & Development and the relatively small customer base.1 One might even tend to think that many companies have adapted their adult device designs to pediatric usage as an afterthought, with mixed results for performance. Pediatric institutions face a different set of challenges when it comes to ensuring patient safety while continuing to strive to provide state-of-the-art services with matching technologies. Management of the pediatric patient is much more daunting than one would imagine: patient age varies from newborn (neonatal) to 18 years old (young adult). Pediatric body weight ranges from 0.5 to 200+ kg, which is a 400-fold range, whereas in the adult setting it is a much narrower weight range with a 5-fold maximum span. The BSA (body surface area)–to–mass ratio could be 3 times larger for an infant when compared with an adult.2 Children’s bodies have different operational requirements to those of adults.3 As a result, pediatric hospitals have to hold a wide range of devices that will accommodate this diverse patient population accompanied by consumables needed to cover the full range of patients. Furthermore, storage space for this expanded equipment inventory and the related consumables is a common problem. Consumable supply inventory is often hard to predict because the age group and acuity of patient fluctuate. All of these factors have a marked impact on both the capital and operating budget of a facility and indirectly impact patient care. In addition, each clinical department within a pediatric facility is presented with its own subset of challenges when faced with lack of pediatric-specific devices.4 This article presents a few different cases on this theme of the challenges for optimizing new medical technologies in the pediatric healthcare environment, to give the reader a perspective on this issue.