The majority of pediatric thoracic and abdominal injuries are successfully treated with nonoparetive management; thus, the role and clinical responsibility of the pediatric emergency physician or intensivist are increased. This review addresses some of the ongoing controversles in pediatric trauma care for the patient with truncal injury. The value of pediatric thoracic injury as a marker for overall severity, recent advances in diagnostic imaging for thoracic injuries; current recommendations for the evaluation of pediatric cardiac injury, and the potential benefits of minimally invasive thotacoscopy are discussed in detail. Recognition of pediatric intraabdominal organ injury, often thought to be difficult in the acute care setting, can be quite accurate with the use of clinical information from physical examination laboratory testing, and diagnostic imaging in the emergency department. A knowledge of the current trauma literature is required for effective care of the child with thoracoabdominal injury.