Abstract: Triage in pediatric emergency settings is a critical process that determines the prioritization of care for infants, children, and adolescents presenting with a wide spectrum of clinical conditions. Unlike adult triage, pediatric triage must account for developmental variations, age-specific physiological norms, communication barriers, dependency status, and distinct disease patterns. Errors in triage may result in delayed treatment, adverse outcomes, and increased mortality. Over the past two decades, several structured triage systems have been developed and validated internationally, including the Emergency Severity Index (ESI), Manchester Triage System (MTS), Canadian Triage and Acuity Scale (CTAS), and the Australasian Triage Scale (ATS). Many of these include pediatric adaptations or dedicated pediatric modifiers. This review article critically examines pediatric-specific triage systems, their theoretical underpinnings, reliability, validity, implementation challenges, and implications for nursing practice. The article also explores innovations such as pediatric early warning scores and digital triage tools. Strengthening pediatric triage processes is essential for enhancing patient safety, optimizing resource allocation, and improving clinical outcomes in emergency departments worldwide.