Public interest in the essential medical care system is increasing. Among them, pediatric medical care is different from adult medical care, so it is more important to secure medical expertise and complete the medical service delivery system. However, the declining birthrate and shortage of pediatricians are threatening the pediatric medical system. The declining birthrate has led to a decline in overall healthcare utilization among children. While there has been a recovery in pediatric healthcare spending since COVID-19, the recovery has been slower in general hospital-level medical institutions, where critically ill pediatric patients are treated. In addition to the weakening of the pediatric specialty medical care system, there is also a fragmented medical service delivery system without a consistent patient referral system. In an effort to overcome these limitations, the government announced the Essential Pediatric Medical Initiative. This study identifies seven limitations of the initiative and suggests alternatives.