Introduction. The majority of pediatric emergency patients are seen in mixed-age emergency departments and triaged by general emergency nurses. Educational methods for teaching pediatric triage education to general emergency nurses have not been well studied, and previous studies of the use of the Emergency Severity Index in children have been performed primarily in centers that are high volume for pediatrics. Methods. A repeated measures, randomized crossover study comparing two different methods of pediatric triage education was conducted. Participants were general emergency triage nurses recruited from a general emergency department that is classified as low volume for pediatrics. Each participant was exposed to both educational methods: paper case studies and high fidelity simulation. Results. All participants had substantial improvement in pediatric triage accuracy as measured by a standardized set of pediatric cases. The previously reported trend towards undertriage of the pediatric patient was observed despite a mean triage agreement rate of 73% at the end of the study period. No differences were observed between groups; the order of the educational intervention did not result in statistically significant differences in triage accuracy. Discussion. A combined approach of paper case studies and high fidelity simulation was effective at improving pediatric triage accuracy among a group of general emergency department nurses with limited exposure to pediatric patients. Persistent trends in undertriage should be studied further.