The special medical needs of children make it essential that health care facilities be prepared for both pediatric and adult victims of bioterrorism attacks, including those resulting from dispersal of airborne or foodborne agents. Moreover, while terrorist attacks on the United States have provoked the development of guidelines for hospital responses to acts of bioterrorism, few have focused on pediatric facilities. Compounding the problem is that many disaster plans that have been designed for children's hospitals are not designed to accommodate large numbers of contagious individuals capable of disseminating highly lethal infectious agents. This document is designed to address the topic of converting pediatric hospitals from standard operating capacity to surge capacity in response to large numbers of children with communicable airborne and foodborne agents. A secondary goal is to assist general emergency departments in developing plans to provide care to large numbers of critically ill pediatric patients. With the recommendations provided in this review, clinicians and hospital administrators will be able to develop unique responses to mass casualty events involving pediatric patients who are victims of bioterrorism. Following the all-hazards approach, the recommendations within this monograph can also be used in consequence management after the exposure to emerging infections of public health importance such as pandemic influenza.