The American Society of Echocardiography has recently published guidelines for chamber and vessel quantification during a pediatric echocardiogram. Because the sizes of cardiovascular structures increase with somatic growth, pediatric quantification requires the adjustment of measurements for the effects of body size in order to determine when a measurement is outside the normal range. A universal pediatric normative database of measurements from a normal population encompassing the full range of body sizes encountered in pediatrics would provide clinicians and researchers a powerful tool to distinguish normal from abnormal values and aid in the management of children with heart disease. However, there are still challenges in the complete acceptance of the recommended pediatric protocols for each cardiac segment, mostly because of historical standard practices, differences with the quantification guidelines for adults, and varying methodologies utilized in currently available pediatric normative databases.