Purpose: Pediatricians play a role in reducing opioid-related harms, including deaths, for patients and families. We examine knowledge, attitudes, and barriers to overdose prevention and naloxone prescribing in the clinical setting by pediatric trainees. Methods: Pediatric trainees at an academic medical center were surveyed using an adapted 17-item instrument examining knowledge, beliefs, and attitudes of naloxone and overdose prevention. Results: Eighty-two percent reported frequent exposure to patients using opioids and at risk of overdose. While 94% felt they had the responsibility to educate patients about overdose risk, only 42% ever discussed overdose prevention. The majority (71%) were aware of naloxone as a prevention measure, but only 10% ever prescribed naloxone. Conclusions: Pediatric residents frequently encountered patients using opioids, but the majority failed to deliver interventions to reduce overdose and related harms. We need concerted efforts to educate pediatric providers on delivering overdose harm prevention to opioid-using adolescents as part of routine clinical care.