Background: Second hand smoke (SHS) exposure has long been correlated with many adverse disease processes, particularly in children. For children growing up with socioeconomic disadvantages and increased exposure to SHS, exposure can have far-reaching consequences. Objective: The purpose of this review was to examine the literature assessing the effects of SHS exposure in children, as well as the perspectives of both parents and providers regarding current practices in cessation counseling. The review also sought out recommendations on ways to increase the influence of pediatricians on parental smoking. Study group: Children under the age of 18 years. Methods: PubMed and MEDLINE were searched systematically. A narrative approach was used because the studies differed in methods and data. Results: The studies showed correlations between SHS exposure and sudden infant death syndrome (SIDS), asthma, altered respiratory function, infection, cardiovascular effects, behavior problems, sleep difficulties, increased cancer risk, and a higher likelihood of smoking initiation. Questionnaires of both parents and pediatricians showed that pediatricians are not consistently carrying out the recommended smoking cessation interventions, with lack of training as a primary barrier. Nevertheless, interventions targeting improved cessation training for both residents and practicing pediatricians have been studied and show promising results. Conclusions: SHS exposure has many detrimental effects on children’s health, particularly for those in low socioeconomic circumstances, for which factors in the built environment accentuated a higher baseline risk. By counseling parents, expanding residency education, and continuing advocacy work, pediatricians can have a significant positive impact on children’s health as related to SHS exposure.