Intraoperative cell salvage (ICS) has been shown to be effective in reducing the rate of allogeneic blood transfusions in pediatric patients who experience large volume blood loss. The effectiveness increases when ICS is used as part of a patient blood management (PBM) program which encompasses preoperative optimization and perioperative strategies for blood conservation. A cost-effective “collect-only” mode is available when large blood loss is anticipated but unpredictable. The patient should be informed of planned cell salvage use, with a documented discussion of risks, benefits, and alternatives. Absolute contraindications to ICS include, but are not limited to, hemostatic agents and vasoactive drugs in the surgical field, and patient or guardian refusal. Malignancy is not an absolute contraindication to ICS. Several professional organizations recommend ICS for adults under specific conditions, but there is a paucity of guidance addressing its use in children who undergo blood loss procedures. The availability of trained staff and established institutional protocols are essential to the safe implementation of ICS.