Pediatric emergency triage plays a decisive role in preventing avoidable deaths and ensuring that children receive care in time to make a clinical difference. Low resource environments struggle to maintain consistent triage performance because staffing, diagnostic capacity, and system organization are often limited. The review evaluated existing triage frameworks and highlights how evidence based design strengthens decision making and patient flow. Many current systems are adapted from adult care, which results in under recognition of pediatric deterioration and inappropriate prioritization. Crowding, inadequate training, and supply shortages are identified as central barriers that reduce triage accuracy and throughput making systems inefficient. Research shows that expanding triage responsibility to trained non physician workers increases capacity where pediatric specialists are scarce. Technology also is promising, particularly low cost digital tools, artificial intelligence models, and point of care biomarkers that improve rapid assessment. However, these improvements are unevenly distributed and often fail to reach marginalized communities. Sustained progress will depend on long term policy adoption, community integration, and models built specifically for the realities of low resource hospitals.