<p>The care of children suffering from heart failure presents unique challenges that are inadequately met at the present time. In the pediatric population, a wide variety of disease processes can result in heart failure, including primary cardiomyopathy as well as an expanding population of children with palliated complex congenital heart disease (CHD). Regardless of the underlying etiology of heart failure, pediatric heart failure outcomes remain poor despite growing resource utilization. In addition, given the overlap in symptomatology between heart failure and more common childhood illnesses, the diagnosis of new onset heart failure in children requires a heightened level of suspicion in combination with early pediatric cardiology consultation. Emerging molecular evidence suggests that pediatric heart failure is distinct from adult heart failure, which may contribute to the limited efficacy of adult heart failure therapies in the children. Significant improvement in pediatric heart failure outcomes will require a shift in the approach to clinical and translation research (including support for pediatric-specific heart failure therapies) as well as widespread implementation of multidisciplinary teams to care for pediatric heart failure in a chronic disease model. Increased awareness among pediatricians, funding agencies, and policymakers regarding the obstacles facing pediatric patients with heart failure is critical to meeting the needs of this complex patient population.</p>