Much of the global burden of death and disease is concentrated in the world's developing countries. There is a core group of prophylactic and therapeutic substances capable of meeting the vast majority of health needs in these countries. Yet, the cost of purchasing pharmaceuticals can account for a high proportion of the total health expenditure of a developing nation. The World Health Organization initiated the Action Program of Essential Drugs to ensure worldwide access to affordable drugs of high quality as well as their rational and appropriate use. The world's children too, by right and by necessity, deserve access to essential drugs that have been tested and formulated for pediatric populations and accompanied by information for their appropriate use in children. The off-label use of drugs in children is common and additional problems of access to health care, and availability and cost of drugs, are even greater for children in poor countries. A first step in addressing these problems would be an international collaborative effort to compile a prioritized list of essential drugs for the world's children.