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Children may be hospitalized at general hospitals or freestanding children’s hospitals. Knowledge about how inpatient care differs at these hospitals is important to inform national research and quality efforts.To describe the volume and characteristics of pediatric hospitalizations at acute care general and freestanding children’s hospitals in the United States.Cross-sectional study of hospitalizations in the United States among children <18 years, excluding in-hospital births, using the Healthcare Cost and Utilization Project’s 2012 Kids’ Inpatient Database.We examined differences between hospitalizations at general and freestanding children’s hospitals, applying weights to generate national estimates. Reasons for hospitalization were categorized using a pediatric grouper, and differences in hospital volumes were assessed for common diagnoses.A total of 1,407,822 (standard deviation 50,456) hospitalizations occurred at general hospitals, representing 71.7% of pediatric hospitalizations. Hospitalizations at general hospitals accounted for 63.6% of hospital days and 50.0% of pediatric inpatient healthcare costs. Median volumes of pediatric hospitalizations, per hospital, were significantly lower at general hospitals than freestanding children’s hospitals for common medical and surgical diagnoses. Although the most common reasons for hospitalization were similar, the most costly conditions differed.In 2012, more than 70% of pediatric hospitalizations occurred at general hospitals in the United States. Differences in patterns of care at general hospitals and freestanding children’s hospitals may inform clinical programs, research, and quality improvement efforts.