The day when children visit their pediatricians, get genome scans, and leave with personalized plans for their health care over the subsequent 20 years remains distant. However, it is important to recognize that genotyping and low-cost sequencing have created an inflection point in the pace of genomic discovery relevant to clinical care. Microbial genomics, the diagnostic evaluation of undiagnosed disease, and reproductive genetics/newborn screening exemplify the need for the practicing pediatrician to have competency in genomics.