This article provides a summary of the history of the development of the subspecialty of child and adolescent psychiatry and the concomitant development of training in the field. The historical perspective provides a context for the discussion of an overview of child and adolescent psychiatry training in the twenty-first century. Four challenges are identified: recruitment, funding, curriculum, and assessment and remediation, each of which is discussed in some depth. The article concludes with a perspective that focuses efforts in training more on basic core competencies rather than the rapidly expanding and changing medical knowledge and specific clinical interventions relevant to the field.