OBJECTIVES: Cost utility analysis (CUA) is the technique of choice for decision making, yet the elicitation of utilities in children poses significant challenges. The objectives were to examine trends over time and to investigate sources for utility weights used in pediatric CUA. METHODS: The Pediatric Economic Database Evaluation (PEDE) Project http://pede.ccb.sickkids.ca/pede maintains a searchable database of pediatric economic evaluations published since 1980. Data on study characteristics are routinely collected from each citation, and health state descriptions, utility weights, and utility sources are extracted for each CUA. Descriptive statistics were used to analyze study characteristics for all studies included in PEDE from 1980 to 2012. RESULTS: The PEDE database includes 2,485 full comparative pediatric economic evaluations. Cost-effectiveness analyses (CEAs) represent 66% and CUAs 22% of studies. The proportion of CUAs has grown over time, from 0% in 1980 to 54% in 2012, with an average annual growth rate of 30% since 2002. Before 2004, CUAs constituted fewer than 15% of pediatric health economic evaluations. In 2009 CUAs overtook CEAs as the most common analytic technique. In contrast, cost-benefit analyses accounted for 27% of studies between 1980 and 1990 and this decreased to 2% in 2012. A total of 1,420 health states were described in 559 CUAs published between 1980 and 2012, but only 60% included utility weights. The majority of these weights were derived from other published sources, including adult studies. CONCLUSIONS: The volume of pediatric CUAs has grown significantly since 1980 and CUAs now surpass CEAs as the most common technique for child health economic evaluation. However, few CUAs elicit utilities prospectively and rely instead on other published studies of unknown quality. Improved methods for eliciting utilities for child health states and the creation of a repository of valid utility weights will contribute to higher quality pediatric CUAs for decision-making.