For many pediatric intensive care units that routinely operate at near maximal census, planning for a surge of critically ill children in the event of a disaster can be daunting. This brief review discusses the framework of surge planning, alterations of standards of care, and providing critical care outside of the pediatric intensive care unit. There are general consensus-based guidelines on conceptualizing and operationalizing critical care surge planning, but there is little published on modeling outcomes of disasters affecting large numbers of children.