Analysis of closed malpractice claims has been used to identify patterns of errors and system problems leading to missed diagnoses in outpatients. This analysis of 20 years of data from the Physicians Insurers Association of America focuses on specific pediatric diagnoses leading to malpractice lawsuits and discusses strategies for pediatricians to minimize the risk of being sued. Missed diagnoses of meningitis, appendicitis, and pneumonia most commonly led to malpractice suits. Cognitive error on the part of physicians may contribute to misdiagnosis for these diagnoses. Problems in telephone triage were also a common underlying factor. A delayed diagnosis of meningitis is discussed in an AHRQ WebM&M commentary.