An informal survey of 65 pediatric emergency department leaders in North America-from 30 U.S. states and 4 Canadian provinces-revealed changes in operations, infrastructure, staffing, and clinical care that were undertaken as a result of the COVID-19 pandemic. The changes identified by the survey respondents were driven by reductions in pediatric patient volumes, a surge of adult patients, clinical considerations related to containment of infection, and financial factors. Survey respondents also reported effects of the pandemic on academic training programs and provider wellness. This report uses the survey responses to provide a snapshot of the adaptability of pediatric emergency medicine departments and clinicians during a public health emergency.