Hemorrhage is the leading cause of preventable death in the United States and carries a disproportionately high mortality in pediatric patients. However, the literature surrounding pediatric trauma resuscitation, specifically massive transfusion protocol (MTP), is less robust than for adults. In this review, we assess the current state of the literature surrounding pediatric MTP (pMTP). Content experts in the field of trauma and pediatric surgery developed an algorithm to be used to identify cases requiring activation pMTP until a definitive scoring system that is both reliable and validated is created.