Caries risk assessment, an essential component of targeted health care delivery for young children, is of paramount importance in the current environment of increasing health care costs and resource constraints. The purpose of this manuscript was to review recent best available evidence behind the factors that influence caries risk assessment and the validity of strategies to assess the caries risk of young children. Moderate to weak evidence supports the following recommendations: (1) Children should have a caries risk assessment done in their first year (or as soon as their first tooth erupts) as part of their overall health assessment, and this should be reassessed periodically over time. (2) Multiple clinical, environmental, and behavioral factors should be considered when assessing caries risk in young children, including factors associated with the primary caregiver. (3) The use of structured forms, although most may not yet be validated, may aid in systematic assessment of multiple caries risk factors and in objective record-keeping. (4) Children from low socioeconomic status groups should be considered at increased risk when developing community preventive programs.