•The EST lateralized language to one hemisphere in almost 80.9% cases.•Contralateral EEG slowing was noted in 73.7% patients, mostly transient which did not affect the overall interpretation.•The EST was unsuccessful in two cases because of persistent diffuse EEG slowing.•The EST was well tolerated in this pediatric population. To review our experience with the Etomidate speech test (EST) for lateralizing language in children undergoing epilepsy surgery evaluation This retrospective study included children (<18 years) with drug refractory focal epilepsy undergoing EST for bilateral or poorly reliable language representation on functional MRI. Data for consecutive children who underwent EST between January 2013 to June 2017 were reviewed. Twenty-one children (mean age at EST, 13.1 ± 4.4 years) were studied, with 19-right hemispheric and 20 left hemispheric injections. Six patients had neurological co-morbidities. Duration of ipsilateral EEG slowing was sufficient for speech testing in all children with a single bolus of Etomidate per carotid artery. Language was lateralized to one hemisphere in 17 (80.9%) and bilateral in two cases. EST was unsuccessful in two patients because of diffuse EEG slowing. Contralateral transient frontal EEG slowing was seen in 14 (73.7%) cases. EST was well tolerated in all the patients. The EST was found to be successful and safe in lateralizing language in most of our drug refractory pediatric epilepsy cohort.