Screen-based simulation (SBS) and 3-dimensional virtual reality (3D VR) applied to pediatric emergency medicine (PEM) leverage digital technology to represent patients, populations, situations, and/or environments. SBS and 3D VR provide realistic, dynamic, safe opportunities for training and testing provider competency, systems-based practice, and environments. SBS engages the user to interact with a computer or mobile device screen to access and respond to content. Virtual reality adds the element of movement and/or allows manipulation of the SBS. 3D VR uses head-mounted ocular technology to create an environment in which the user is immersed as an active participant. SBS and 3D VR types include virtual patients, virtual worlds, screen-based haptic trainers, and resource management simulators. Advantages of SBS and 3D VR simulation over mannequin-based simulation are that it is infinitely replicable; can be distributed widely to devices simultaneously; is portable; enables tracking, storing, and analysis of massive amounts of usage and performance data; and does not require the presence of a live instructor. Disadvantages include cost, technical problems, and lower fidelity. We provide examples of types of SBS and 3D VR relevant to PEM that are currently available and in development; PEM-specific uses of SBS and 3D VR for training and testing, as well as uses for research to determine best practices for acquiring and retaining PEM knowledge and skills; and strategies for integrating SBS and 3D VR into training and PEM practice.