Much has been written about the ethical challenges inherent to allocation of scarce resources. Allocation frameworks and triage protocols guide our efforts to equitably and transparently determine the priority with which an individual should receive a scarce resource. Often rooted in Utilitarian principles, these frameworks seek to maximize the benefit of the available resources by providing the greatest good for the greatest number of people. While most agree that measures of social worth ought not be included in decisions regarding allocation of scarce resources, consensus on other traits, such as age, has not been achieved. Here we explore whether it is ethically permissible to prioritize pediatric patients over adult patients when considering allocation of scarce surgical resources. Our systematic review of the literature based upon PICOS criteria identified 27 articles that addressed this topic. Articles highlight the Lifecycle/Fair Innings argument, Life-Years Saved calculations, the ideas that age affects us all equally and that inclusion of age in allocation frameworks may mitigate disparities, and the fact that we support other social systems designed to provide limited resources to those with fewer previous experiences as support for the ethical permissibility of prioritizing pediatric patients for scarce resources. Ageism and the concern that pediatric patients may not value the scarce resources as much as adult patients were used to argue against prioritization of pediatric patients. Based upon this literature review, we recommend: (1) Age is an important criterion to include in frameworks used to guide allocation of scarce resources and (2) It is ethically permissible to prioritize pediatric patients for allocation of scarce resources.