Background <p>Maintaining a workforce capable of providing safe and effective care is a critical priority of healthcare systems worldwide, with growing concerns about paediatric workforce and increasing demand on acute services. Ensuring that graduating doctors can recognise and initiate management of acutely ill children is therefore an essential competency in medical education. However, opportunities for medical students to gain experience in paediatric emergencies during undergraduate clinical placements are often limited, unpredictable and ethically constrained. Consequently, students may graduate with little exposure to rare but high-stakes paediatric scenarios despite being expected to recognise clinical deterioration and initiate early management. Paediatric simulation-based education (SBE) therefore provides a safe environment that allows deliberate practice of complex clinical situations without risk to patients and has been shown to improve clinical performance, knowledge, technical skills and communication abilities. Despite these advantages, integration of paediatric SBE into undergraduate curricula remains variable. This scoping review aims to map the current literature on SBE in paediatric undergraduate training, examining educational modalities, outcomes and barriers to implementation.</p> Methods <p>This scoping review followed PRISMA-ScR guidelines. Four databases (PubMed, Scopus, Embase, Cochrane) were searched for studies published between January 2010 and July 2025. Inclusion criteria focused on undergraduate medical students, paediatric simulation training, and empirical study designs. Data were extracted on study characteristics, modalities, outcomes, and barriers to implementation.</p> Results <p>Thirty studies met the inclusion criteria. The United States (<i>n</i> = 10), France (<i>n</i> = 3), and Brazil (<i>n</i> = 3) were the most represented countries. Randomized controlled trials (<i>n</i> = 11) and quasi-experimental designs (<i>n</i> = 10) predominated. High-fidelity manikins and virtual reality were the most common modalities. Outcomes included improvements in clinical reasoning, procedural skills, and student confidence, measured using OSCEs and validated tools. Reported barriers to implementation included financial cost, faculty training, and maintenance of technical equipment. No studies from the Middle East/North Africa region were identified in the specified timeframe.</p> Conclusions <p>Simulation-based education enhances paediatric undergraduate training and prepares learners to manage rare but critical scenarios, supporting its integration into medical curricula. The limited number of studies from the Middle East/North Africa region highlights an important geographical gap in literature. Future research should explore long-term outcomes, cost-effectiveness, and strategies for sustainable, context-specific implementation.</p>