Much of what we know about the pathogenesis and treatment of asthma has been learned from adult studies. Recently, a dramatic shift toward the pediatric age group has occurred in both of these areas. Such studies in children have overall supported similarities with the adult population with regard to pathogenesis (airway inflammation) and treatment (anti-inflammatory controller medications). However, the onset of asthma symptoms in less than 5 years is 80% of the time, yet controller medications approved for children under 4 years of age have generally not been available. This treatment gap was recently filled by the FDA approval of two important asthma controller medications. This review will focus on the use of leukotriene receptor antagonists and inhaled corticosteroids, which were recently approved for use in asthmatic children under 4 years of age.