Access to pediatric healthcare services remains a major public health challenge in Nigeria, particularly in the context of persistent dependence on out-of-pocket (OOP) healthcare financing. This paper critically examined the barriers to accessing pediatric healthcare services in Nigeria with specific focus on the burden of out-of-pocket payments and their policy implications. The study adopted a qualitative and analytical approach through extensive review of existing literature, policy documents, and institutional reports relating to healthcare financing and child healthcare access in Nigeria. The paper identified several interconnected barriers affecting pediatric healthcare utilization, including high out-of-pocket healthcare expenditure, weak health insurance coverage, poverty, poor primary healthcare infrastructure, rural–urban disparities, and weak implementation of healthcare policies. The study revealed that excessive dependence on direct household healthcare payments contributes significantly to delayed treatment-seeking behaviour, catastrophic health expenditure, household impoverishment, inequitable healthcare access, and preventable child morbidity and mortality. The paper further established that despite various healthcare reforms such as the National Health Insurance Authority (NHIA) Act and the Basic Health Care Provision Fund (BHCPF), financial risk protection for many Nigerian households remains inadequate. The study concluded that improving pediatric healthcare access in Nigeria requires comprehensive healthcare financing reforms, increased public sector investment in healthcare, expansion of health insurance coverage, strengthening of primary healthcare systems, and effective implementation of health policies aimed at achieving Universal Health Coverage (UHC). The paper recommended reduction of out-of-pocket healthcare payments, expansion of child-focused health insurance schemes, revitalization of primary healthcare centres, strengthening of rural healthcare services, and adoption of equity-driven healthcare policies to improve child health outcomes in Nigeria.