Purpose <p>Effective triage in emergency settings is crucial to reduce pediatric mortality and improve timely access to care. However, in low-resource settings, the sustainability of models still faces barriers. This review aims to assess pediatric emergency triage in low-resource settings by employing evidence-based strategies, task-shifting, and technological innovations.</p> Methods <p>A comprehensive literature review was conducted to assess current pediatric triage models, identify barriers to effective triage, and explore innovations suitable for low-resource settings.</p> Results <p>Key challenges include overcrowding, limited training, scarce diagnostic resources, and inappropriate adaptation of adult triage systems. Successful models of triage assessment and treatment show promise but face sustainability challenges. Task-shifting to non-physician clinicians and community health workers enhances capacity, while digital tools, artificial intelligence, and point-of-care biomarkers improve diagnostic precision and triage accuracy. Ethical challenges and inequitable access persist, particularly for marginalized populations.</p> Conclusion <p>Optimizing pediatric triage in low-resource settings requires a multipronged approach including policy integration, capacity building, technology adoption, and community involvement. Sustainable triage systems should combine standardized protocols, training, real-time decision support, and continuous quality improvement tailored to local contexts.</p>