The use of data from the National Clinical Database (NCD) is becoming more important in pediatric surgery. First, it is possible to review all surgical data in the NCD. Although pediatric surgeons treat a wide variety of conditions, with the exceptions of common ones such as appendicitis or inguinal hernia, rare anomalies with an incidence of only one in 1,000 births account for most cases. Therefore the number of surgeries for each type of rare anomaly performed in institutions specializing in pediatric surgery annually is very few. If many institutions do not accumulate large numbers of cases over the short-term, it will be impossible to analyze useful surgical data. The use of NCD data can therefore contribute to safe, clear medical care. Second, the Japanese neonate/infant mortality rate is the world's lowest, but on the other hand, the mortality rate of 1-3-year-olds is around the 20th lowest. The leading cause of death in this age-group is accident, and therefore the development of a childhood emergency medical system is important to improve this situation. Pediatric surgeons have an important role to play in emergency care and only they can prevent complications from surgery. However, until the creation of the NCD it was not clear which types of medical care were given at which institutions. Analysis of the reasonable placement of specialists or the ideal system of pediatric surgical emergency care can now be conducted based on scientific grounds by analyzing data from the NCD provided by all surgeons. For those performing pediatric surgery, the true value of the NCD will be determined in the future based on how they cope with this paradigm shift.