Pediatric medication errors are common yet studied less in the ambulatory setting than in the inpatient arena. This prospective cohort study of six outpatient practices identified more than 1200 medication errors with minimal potential for harm, and more than 460 potentially harmful ones deemed near misses. Overall, a remarkable half of all prescriptions had errors and a fifth of those had potential for harm. The authors were particularly interested in understanding the differences between errors with minimal potential for harm and near misses. The prescribing stage was responsible for nearly 95% of the errors in the former category but only 60% of the latter. Whereas inappropriate abbreviations were the most common cause in the minimal harm group, dosing errors were most common in the near misses. Their findings suggest that e-prescribing may effectively address many of the issues identified, particularly around provider illegibility, but further solutions will also be needed.