Child care settings, such as nursery schools and preschools, provide important opportunities to increase physical activity in children aged 2 to 5 years. Because of the large numbers of children enrolled, physical activity interventions at child care facilities have the potential to reach many children at an age when behaviors are influenced more easily. To learn more about this possibility, the authors conducted a systematic review of the published literature for intervention studies conducted at organized child care settings that focused on increasing children’s physical activity levels. Although 8 databases were searched from their inception, only 9 studies were found that met inclusion criteria, all of which were published since 2003. Of these, 7 studies implemented some type of organized educational program or specific curricula, whereas 2 studies implemented environmental changes. Intervention length across studies varied from 2 days to 12 months. Five studies demonstrated a positive change in physical activity; however, the limited number of studies included and the range of research quality made it difficult to draw clear conclusions. A number of potential targets for increasing physical activity at child care settings were identified, including active opportunities, sedentary opportunities, physical environment, staff training and behavior, center policies, and outreach. All these areas seem to merit further investigation, and specific research questions for each are discussed.