Since 2016, the pediatric emergency centers (PECs) have been selected by the Korean Ministry of Health and Welfare, but there are still many problems in their designation and operation. The authors, affiliated with the policy research team in the Korean Society of Pediatric Emergency Medicine, sought to identify the current status and plans for improvement of PECs in Korea. The problems in the designation and operation are the disproportionate regional distribution of the PECs, financial difficulties in meeting the designation criteria, and recruitment of dedicated pediatric emergency specialists. To improve this, it is necessary to designate additional PECs and analyze the appropriateness of insurance cost, to strengthen the role other than the community practice, and to reinforce back-up treatment by pediatric sub-specialists in PECs.