Through an analysis of national hospitalization data, mortality records, and a detailed case review, this chapter examines the profound impact that the opioid crisis has had on children in the United States, a population that is often overlooked in the national discourse. Comprehensive data spanning more than 25 years reveals that more than 15,000 children have died from opioid poisonings in the United States and suggest that another 70,000 have been hospitalized for serious nonfatal exposures. My research documents how the pediatric opioid crisis has evolved from primarily prescription opioid poisonings to today’s fentanyl-driven epidemic, which now accounts for 95% of opioid deaths in children. Through a review of nearly 1700 child fatality reports, I highlight recurring patterns across different age groups and family, home, and community factors that place children at risk, including how parental substance use and mental health disorders increase vulnerability. A case study of a 10-month-old who died from fentanyl intoxication despite multiple opportunities for intervention illustrates how system failures and critical gaps in coordination between healthcare providers and child welfare agencies contribute to these preventable tragedies. For families and communities, these findings underscore the extent to which children are at risk from opioids and how practical safety measures can mitigate the risks that opioids pose to children; for healthcare providers, public health officials, and child-welfare advocates, they highlight the need for standardized screening methods, prevention protocols, and policy changes. Protecting children from opioid exposure requires both clinical vigilance and community-based solutions that recognize children as central to addressing America’s ongoing opioid crisis.