The purpose of this study was to compare emergency department (ED) utilization and treatment patterns of Asian American children with children from other racial/ethnic groups. A cross-sectional design was used to examine all visits by children under 18 years to two urban pediatric EDs between June 2011 and May 2012. Demographic, socioeconomic, and clinical data were extracted from the patients' electronic medical records. A logistic regression model was used to assess the patients' odds of high ED utilization (at least 4 ED visits in the study period), controlling for potential confounders. The overall sample consisted of 86,922 ED visits, and over 4% were made by Asian American children. Asian Americans' ED usage and treatment patterns reflected those of Whites and not of other minority racial/ethnic groups in areas such as elopements, visit frequency, time and day of visit, time to exam, length of stay, tests ordered, inpatient admissions, and triage scores. Among all racial/ethnic groups, Asian Americans had the largest percentage of patients living in the lowest income level (45%). After adjusting for demographic, socioeconomic, and clinical covariates, Asian American children were the least likely to have high ED utilization. White patients were 2.57 (95% confidence interval 1.89 - 3.51) times more likely to have high ED utilization than Asian Americans, with all other groups having even higher odds. In conclusion, despite similar ED behaviors as Whites, Asian American children were significantly less likely to use the pediatric ED than all other racial/ethnic groups.