While several studies have evaluated patient/parent's preference for physicians' attire in pediatric clinics, pediatric wards, and in adult emergency settings, none has been done in a pediatric emergency department (PED). Furthermore, factors that may influence these preferences such as severity of illness, time of visit, and type of emergency department (ED) visit (surgical vs medical) have not been considered. This study was designed to evaluate parents' attitudes toward pediatric emergency department physicians' professional appearance. By way of a survey, the parents/guardians of 360 patients presenting to Children's Hospital Medical Center PED in Cincinnati, Ohio, were presented with eight photographs of physician pairs (male/female) dressed in different levels of attire ranging from a formal style (white laboratory coat, dress shoes, and tie) to surgical scrubs with tennis shoes. They were asked to choose the pair of practitioners they liked the most and the least, and to indicate whether their perception of competence was affected by physician attire. Preferences were analyzed by gender, age, responsible person, insurance group, type of visit, severity of illness, and time of visit. The results showed that, when asked which physicians they would prefer the most to evaluate their child in the PED, the majority of subjects chose photographs of physicians dressed most formally (158/360 [chi 2, P < 0.0001]). When asked which physician they preferred the least, 229 subjects chose the photograph of doctors wearing no white laboratory coat, no tie, and tennis shoes (chi 2, P < 0.0001). Neither severity of illness, time of visit, insurance group, age, race, or gender of the guardian or parent had a significant statistical effect on the most preferred or disliked attire. However, subjects visiting the ED between 7 AM and 11 PM clearly preferred the formal attire when compared with the 11 PM to 7 AM shift (chi 2, P = 0.016). A significant difference was noted between the preference of surgical scrubs by the parents of patients with surgical emergencies (42/90 [58%]) vs medical patients (30/270 [23%]) (chi 2, P < 0.0001). Combining parents' selections, 75% preferred photographs of physicians wearing white laboratory coats, while 84% chose photographs of doctors who wore tennis shoes as the least liked physicians. Seventy-two percent of parents felt the physicians they preferred the most were not necessarily more capable than the other choices. Sixty-nine percent of subjects felt that it did not matter what their pediatric emergency physician was wearing. Formal attire was associated with "professional appearance" in 64% of the responses. Our study demonstrated that: 1) pediatric emergency physician's attire does not matter to most parents. However, when asked to choose, clear preferences for likes and dislikes become evident. 2) Parents/guardians prefer pediatric emergency physicians who wear formal attire, including white laboratory coat, and do not like casual dress with tennis shoes. 3) Severity of illness, insurance type, and age, race, and gender of guardians do not affect preferences. 4) Parents of patients with surgical emergencies are more likely to prefer doctors wearing surgical scrubs. 5) Parents visiting the ED during night shift (11 PM to 7 AM) showed less interest in formal attire. Our findings may assist in parent/physician interaction in a PED setting.