Pediatric critical care (PCC) plays a crucial role in reducing illness and death rates globally. However, in low and middle-income countries (LMICs), PCC services are not yet well-established in many hospitals. Necessary resources, including trained healthcare staff and access to necessary medications and equipment are lacking in many pediatric intensive care units (PICUs) in LMICs. Moreover, there is a shortage of PCC training programs and certification process for healthcare providers working in PICUs and high dependency areas. Establishing a PICU in a resource-limited setting requires careful resource utilization. The fundamental building blocks include training healthcare professionals, selecting appropriate cost-effective equipment, and having supportive leadership. If these building blocks are established in a sustainable manner, a suitable critical care service can be maintained, leading to a significant reduction in pediatric mortality and morbidity. Furthermore, there is a pressing need for conducting more researches on PCC in RLSs to provide a comprehensive view of the epidemiology and outcomes of critical illness in children. Additionally, researches should be advanced to develop appropriate guidelines for managing pediatric critical illness in RLSs and focus on low-cost critical care technology, which is vital to support critical care in RLSs. In this review, we provide an overview of the current state of PCC services in LMICs based on the current literature, and propose a contextual framework to improve these services.