The negative consequences of environmental tobacco smoke (ETS) in children have been well documented. Our objective is to assess whether children of unplanned pregnancies are at increased risk for ETS exposure. Data were collected through interviews of mothers who accompanied their children to the Children's Hospital of Michigan, Detroit, Michigan. Associations of ETS exposure with unplanned pregnancy were analyzed using the χ2 test and stratified by maternal smoking status. Results from the bivariate analysis were further verified using a multiple logistic regression method to control for significant covariates. Among the sample of 399 children, 125 (31.3%) were born from unplanned pregnancies; 47.2% of the unplanned children and 25.6% of the planned children were exposed to ETS (χ2 = 18.4, p < .01). Unplanned children of non-smoking mothers also experienced higher levels of exposure to ETS compared with planned children (22.45% vs. 10.05%, χ(2) = 5.50, p < .05). The association remained significant after controlling for covariates (adjusted odds ratio = 2.45; 95% confidence interval = 1.03, 5.84; p < .05). Findings of this study suggest the importance of preventing ETS in urban children, particularly those from unplanned pregnancies. Copyright © 2012 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.