The days of healthcare professionals ignoring the word “dollar” are over as we face universal calls for our $2.7 trillion health care system to be financially sustainable and not waste an estimated $558 billion to $1.263 trillion per year. Referring to six “wedges” of waste discussed by Berwick and Hackbarth as failures of care delivery, failures of care coordination, overtreatment, administrative complexity, pricing failures, and fraud and abuse, what is the involvement of the child healthcare delivery system? How should pediatricians think about saving money when child health accounts for less than one tenth of total spending on one quarter of the American population – and when total waste on “administrative complexity” may exceed every dollar devoted to efforts to improve the well-being of children?