The purpose of this report is to review the current knowledge base related to the epidemiology, microbiology, diagnosis, and morbidity and mortality of ventilator-associated pneumonia and to review strategies to reduce the risk of acquiring this condition. Published guidelines are based largely on data from adult populations, and implications for the pediatric population must be extrapolated to a great extent. Some interventions, including elevation of the head of the bed for most patients and deep vein thrombosis prophylaxis in older pediatric patients, seem reasonable based on available literature. The use of daily sedation holidays must be weighed against the risk of inadvertent extubation. The routine use of stress ulcer prophylaxis in the pediatric population cannot be supported by the current literature.