Asthma is a chronic respiratory condition affecting 6.5% of the pediatric population in the United States. Inhaled medications are the mainstay of treatment of asthma. Delivering inhaled medications to children with asthma has several challenges. Personalized device selection and education are paramount for successful asthma treatment. The complexity of drug delivery in pediatric asthma is potentiated by the anatomical, physiological, and behavioral differences present in children. In addition, aerosols are given for preventive and for rescue reasons. The latter might also occur in children receiving respiratory support. This article reviews patient- and device-related factors affecting inhaled drug delivery and deposition. It also provides a framework to understand variations of drug delivery that occur during transition between different respiratory support devices. This review also discusses clinical trial data comparing different devices. Finally, guidance on how to choose the right delivery device for each patient is provided.