While it may be harmless in most cases, piston slap can be a real problem. Some of GM's slap-happy engines have had significant wear and high oil consumption issues. I'd like to think my 4Runner is better built than any GM, but I'm not 100% sure. I'm going to send in an oil sample for analysis to get an idea if I really have something to worry about.
The last few days I've done some cold weather startup tests. Even on really cold days the engine sounds fine idling in park, no knocking even right after startup. If I put it in reverse or drive without letting it warm up for several minutes, I notice a hearty knocking sound. While sitting in park, if I bring the engine up to 2500 RPM (30 seconds after startup), I hear a higher pitched knocking / tapping clatter that seems more like a piston slap. It sounds kind of like my old worn out single cylinder 2 stroke dirt bike. It's definitely a higher pitch than the "hearty" knock I first described. I can't wait to see what ol' Bob the oil guy says...