The Pacific Island countries are home to some 2 million people, of whom just over 900,000 are under 18 years of age (UNICEF, 2007). In this article I briefly review the progress Pacific Island countries have made towards their Millennium Development Goals (MDGs), with a particular focus on MDG4 (reduce child mortality) and MDG5 (improve maternal health). I then highlight some of the support being provided by the United Nations Children's Fund (UNICEF) in partnership with many agencies across the region to assist countries to advance their child-related MDGs. Finally, I consider some of the challenges to sustaining MDG progress for children in Pacific Island countries, especially the current global economic crisis.