Objectives: To evaluate the effectiveness of an educational intervention to decrease pediatric emergency department (PED) visits and adverse care practices for upper respiratory infections (URI) among predominantly Latino Early Head Start (EHS) families. Methods: Four EHS sites in New York City were randomized. Families at intervention sites received 3 1.5-hour education modules in their EHS parent-child group focusing on URIs, over-the-counter medications, and medication management. Standard curriculum families received the standard EHS curriculum, which did not include URI education. During weekly telephone calls for 5 months, families reported URI in family members, care sought, and medications given. Pre- and post-intervention knowledge-attitude surveys were also conducted. Outcomes were compared between groups. Results: There were 154 families who participated (76 intervention, 78 standard curriculum) including 197 children 4 years old. Families were primarily Latino and Spanish-speaking. Intervention families were significantly less likely to visit the PED when their young child (age 6 to 48 months) was ill (8.2% vs 15.7%; P = .025). The difference remained significant on the family level (P = .03). These families were also less likely to use an inappropriate over-the-counter medication for their 2-year-old child (odds ratio, 0.29; 95% confidence interval, 0.09--0.95; 12.2% vs 32.4%, P = .034) and/or incorrect dosing tool for their 4-year old child (odds ratio, 0.24; 95% confidence interval, 0.08--0.74; 9.8% vs 31.1%; P .01). The mean difference in Knowledge-Attitude scores for intervention families was higher. Conclusions: A URI health literacy-related educational intervention embedded into EHS decreased PED visits and adverse care practices. (author abstract)