Tobacco use and secondhand tobacco smoke exposure of children are a significant problem faced by pediatricians. This article reviews the recommendations of the 2008 update of the guideline Treating Tobacco Use and Dependence and their application in the pediatric setting.Every tobacco user seen in the clinical setting, including parents and other persons who are not patients, should be offered evidence-based treatment. At minimum, treatment consists of brief counseling and access to resources that support quit attempts. Pharmacotherapies should be offered to all tobacco users, except for pregnant women, adolescents, and other groups for which effectiveness of pharmacotherapies has not been shown. The five As (ask, advise, assess, assist, and arrange follow-up) continue to be recommended as the key points in counseling.Tobacco use is a chronic disease that develops early in life and affects many patients and families seen in the pediatric setting. Every tobacco user should be offered treatment, including parents and other family members, and the most effective treatment is a combination of counseling and pharmacotherapies.