Background: Severe coronavirus disease 2019 (COVID-19) is infrequent in children and shows a mortality rate of around 0.08%.This study aims to explore international differences in the pediatric mortality rate.Methods: We analyzed several countries with populations over 5 million that report disaggregated data of COVID-19 deaths by quinquennial or decennial age groups.Data were extracted from COVID-19 cases and deaths by age database, National Ministeries of Health, and the World Health Organization.Results: We included 23 countries in the analysis.Pediatric mortality varied from 0 to 12.1 deaths per million children of the corresponding age group, with the highest rate in Peru.In most countries, deaths were more frequent in the 0-4-year-old age group, except for Brazil.The pediatric/general COVID-19 mortality showed a great variation and ranged from 0% (Republic of Korea) to 10.4% (India).Pediatric and pediatric/general COVID mortality correlates strongly with 2018 neonatal mortality (r = 0.77, p < 0.001; and r = 0.88, p < 0.001, respectively), while shows a moderate or no correlation (r = 0.47, p = 0.02; and r = 0.19, p = 0.38, respectively) with COVID-19 mortality in the general population.Conclusions: International heterogeneity in pediatric COVID-19 mortality importantly parallels historical neonatal mortality.Neonatal mortality is a well-known index of the quality of a country's health system, which points to the importance of social determinants of health in pediatric COVID-19 mortality disparities.This issue should be further explored.