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To evaluate residents' skills in performing basic mathematical calculations used for prescribing medications to pediatric patients.In 2001, a test of ten questions on basic calculations was given to first-, second-, and third-year residents at Miami Children's Hospital in Florida. Four additional questions were included to obtain the residents' levels of training, specific pediatrics intensive care unit (PICU) experience, and whether or not they routinely double-checked doses and adjusted them for each patient's weight. The test was anonymous and calculators were permitted. The overall score and the score for each resident class were calculated.Twenty-one residents participated. The overall average test score and the mean test score of each resident class was less than 70%. Second-year residents had the highest mean test scores, although there was no significant difference between the classes of residents (p = .745) or relationship between the residents' PICU experiences and their exam scores (p = .766). There was no significant difference between residents' levels of training and whether they double-checked their calculations (p = .633) or considered each patient's weight relative to the dose prescribed (p = .869). Seven residents committed tenfold dosing errors, and one resident committed a 1,000-fold dosing error.Pediatrics residents need to receive additional education in performing the calculations needed to prescribe medications. In addition, residents should be required to demonstrate these necessary mathematical skills before they are allowed to prescribe medications.