There is ample evidence that children are harmed by tobacco smoke exposure. Pediatricians concerned about tobacco's effect on children have often focused on harm reduction, i.e. counseling parents to smoke outside. More recently, pediatricians have become interested in directly addressing smoking cessation. This review concentrates on why pediatricians are in a unique position to access smokers, and why they should specifically act as smoking cessation counselors. The available literature on the pediatrician as smoking cessation counselor for both parents and adolescents is reviewed. A brief introduction to the various evidence-based counseling methods is also provided.