In children, injury is the most common cause of death. Thoracic and abdominal trauma are both associated with high morbidity and mortality, and they warrant a thorough evaluation. Abdominal trauma occurs in 25% of children with major trauma and is responsible for 9% of all trauma deaths. Because it can delay care, lack of recognition of intra-abdominal injury increases morbidity and mortality. Thoracic trauma comprises only 4–6% of pediatric trauma but is related to 14% of pediatric trauma-related deaths and is the second most common cause of mortality in pediatric trauma. This chapter discusses the keys to the evaluation of the pediatric trauma patient with thoraco-abdominal injury, including the evidence-based approach and algorithms to be utilized by medical personnel.