In the pediatric population, medication errors occur at rates similar to those of adults. However, given the need for careful weight-based dosing of medications for pediatric patients, fast-paced emergency department settings may increase this risk. In this study, two pediatric pharmacists used a data collection instrument to retrospectively characterize the frequency and nature of medication errors in more than 175 cases. Investigators discovered errors in half the patient cases where a medication was prescribed. Incorrect physician orders accounted for the most common error source. The authors advocate for system redesign to prevent such a high rate of errors, particularly in rural settings where resources may be limited.