Introduction: This study aimed to determine the relationship between patients presenting to the pediatric emergency department (PED) and potential tobacco smoke exposure (TSE)-related illnesses. Methods: A retrospective review of electronic medical records of pediatric emergency department patients (N = 116,084) was conducted. Sociodemographic characteristics, TSE-related illnesses, and TSE documentation were extracted. Logistic regression analyses were performed. Results: More than one fifth (21.7%) of patients had TSErelated illnesses. Patients who were younger, male, non-White, or Hispanic; had Medicaid/Medicare insurance, had low triage acuity; or were admitted to any non-intensive care unit or intensive care unit were significantly more likely to have TSE-related illnesses. Twenty-eight percent of patients with TSE documentation had positive TSE status. Although regression models for positive TSE indicated similar findings, no difference was found based on ethnicity. Discussion: Pediatric emergency departments, especially those that care for large numbers of children, should offer tobacco interventions that target at-risk populations and caregivers who are most likely not receiving interventions in other health care settings.