Racism– a system operating at the intrapersonal, interpersonal, institutional, and structural levels– is a serious threat to the health and wellbeing of children and adolescents. This narrative review highlights racism as a social determinant of health, and describes how racism breeds disparate pediatric health outcomes in infant health, asthma, Type 1 diabetes, mental health, and pediatric surgical conditions. Key examples include the association of residential racial segregation and the alarming infant mortality rate among Black infants as well as the role of redlining and discriminatory housing practices on asthma morbidity among Black children and adolescents. Furthermore, inequitable care practices such as (1) racial and ethnic disparities in insulin pump usage in patients with Type 1 diabetes, (2) lower rates pharmacotherapy initiation in racialized children with mental health disorders, and (3) decreased pain medication management and confirmatory imaging in Black children with acute appendicitis, highlight the role of interpersonal racism in propagating poor health outcomes. An urgent call to action is needed to address pediatric health inequities and ensure all children can live healthy lives. Key strategies must tackle racism at the individual, institutional, and structural levels and include building a diverse workforce, prioritizing research to describe the impact of racism on pediatric health outcomes, initiating improvement efforts to close equity gaps, building community partnerships, co-designing solutions alongside patients and families, and advocating for policy change to address the social conditions that impact children and adolescents of color.

种族主义——一种在个人、人际、机构和结构层面运作的系统——对儿童和青少年的健康和福祉构成严重威胁。这篇叙述性评论强调了种族主义作为健康的社会决定因素，并描述了种族主义如何在婴儿健康、哮喘、1 型糖尿病、心理健康和儿科手术条件中滋生不同的儿科健康结果。关键例子包括居住种族隔离与黑人婴儿中令人震惊的婴儿死亡率之间的关联，以及红线和歧视性住房做法对黑人儿童和青少年哮喘发病率的作用。此外，不公平的护理实践，例如 (1) 1 型糖尿病患者使用胰岛素泵的种族和民族差异，（2）在患有精神健康障碍的种族化儿童中较低的药物治疗开始率，以及（3）在患有急性阑尾炎的黑人儿童中减少止痛药管理和确认成像，突出了人际种族主义在传播不良健康结果中的作用。需要紧急呼吁采取行动，解决儿科健康不平等问题，并确保所有儿童都能过上健康的生活。关键战略必须在个人、机构和结构层面解决种族主义问题，包括建立多元化的劳动力队伍、优先研究描述种族主义对儿科健康结果的影响、发起改善工作以缩小公平差距、建立社区伙伴关系、共同设计解决方案与患者和家属一起，