Natural and man-made disasters are unpredictable but certainly will include children as victims. Increasingly, knowledge of pediatric disaster preparedness is required of emergency and primary care practitioners. A complete pediatric disaster plan comprises the following elements: appropriate personnel and equipment, disaster- and venue-specific training, and family preparedness. Disaster preparedness exercises are crucial for training plan implementation and response evaluation. Exercise content depends on local hazard vulnerabilities and learner training needs. Postexercise evaluations follow a stepwise process that culminates in improved disaster plans. This article will review disaster planning and the design, implementation, and evaluation of pediatric disaster exercises.