OBJECTIVE Pizza consumption is a top contributor to children's and adolescents' caloric intake. The objective of this study was to examine children's and adolescents' pizza consumption patterns and its impact on their energy and nutrient intake. METHODS Twenty-four-hour dietary recall data for children aged 2 to 11 and adolescents aged 12 to 19 were drawn from the 2003-2004, 2005-2006, 2007-2008, and 2009-2010 National Health and Nutrition Examination Survey. We tested changes in consumption patterns, including by race/ethnicity, income, meal occasion, and source. Individual-level fixed effects regression models estimated the impact of pizza consumption on total energy intake (TEI) and intakes of sugar, saturated fat, and sodium. RESULTS From 2003-2004 to 2009-2010, overall energy intake from pizza declined 25% among children (110 to 83 kcal, P ≤ .05). Among adolescents, although caloric intake from pizza among those who consumed pizza fell (801 to 624 kcal, P ≤ .05), overall pizza intake remained unchanged due to slightly higher pizza consumption prevalence. For children and adolescents, pizza intake fell (P ≤ .05) at dinner time and from fast food. For children and adolescents, respectively, pizza consumption was significantly associated with higher net daily TEI (84 kcal and 230 kcal) and higher intakes of saturated fat (3 g and 5 g) and sodium (134 mg and 484 mg) but not sugar intake, and such affects generally did not differ by sociodemographic characteristics. Pizza consumption as a snack or from fast-food restaurants had the greatest adverse impact on TEI. CONCLUSIONS The adverse dietary effects of pizza consumption found in this study suggest that its consumption should be curbed and its nutrient content improved.