The preoperative assessment of the patient's health status is an indispensable part of planning any procedure where the patient is undergoing anesthesia. The American Society of Anesthesiologists' Physical Status classification – known as ASA PS classification - is routinely used today to assess the risks of anesthesia and perioperative mortality of patients undergoing surgery. Given the imperfections of ASA status as a predictor of perioperative risk in children, there are attempts to develop new risk assessment systems and guidelines specific to children. Two novel tools for assessing the preanesthetic risk in children are briefly presented: Pediatric Risk Assessment (PRAm) score and ''NARCO-SS'' (neurological, airway, respiratory, cardiovascular, other – surgical severity) score. Already in the first evaluations, the "NARCO-SS" system has proven to be a more precise measure of perioperative risk in children compared to the ASA status. Finally, the aim of this paper was to establish the value of the current guidelines in assessing the preoperative risk in children. The algorithm and the specificity of the preanesthesia evaluation process in children with an emphasis on identifying risk factors that could affect complications during and immediately after anesthesia are presented. Careful risk assessment is the basis for designing a plan for intraoperative child care, recovery after anesthesia, and perioperative pain management. Safety and success of the anesthetic procedure depends on valid preoperative risk assessment.