Purpose: To evaluate trends in the representation of pediatric-related articles in leading general ophthalmology journals for 20 years. Methods: A list of all relevant publications from five top-ranking general ophthalmology journals (Ophthalmology, JAMAOphthalmology, AmericanJournalofOphthalmology, British Journal of Ophthalmology, and Acta Ophthalmologica) between January 1997 and December 2016 was retrieved using the PubMed search engine. Articles captured by the age filter “child: birth-18 years” were considered pediatric. The annual pediatric publication rate was calculated as the fraction of pediatric articles out of the total number of articles within each year for every journal. A linear mixed effects model was applied to determine the trend in the pediatric publication rate during the study period. Results: A total of 37,181 publications were included in the analysis, of which 7,828 (21.1%) were classified as “pediatric.”During the study period, there was a statistically significant decrease in pediatric publication rates, with an annual absolute decrease of 0.23% (P = .01), yielding relative reduction by approximately 18% over the past two decades. Conclusions: Representation of pediatric articles progressively decreased in general ophthalmology journals. This trend has major implications regarding exposure of non-pediatric ophthalmologists to the new developments in pediatric management. In addition, this may imply a difficulty to publish pediatric-related articles in high-ranking general ophthalmology journals.