A 20-year experience at The University of Chicago in dealing with chest injuries in pediatric patients has been reviewed. The clinical presentation, including results of diagnostic measures, and the initial and definitive management of thoracic trauma in children are discussed. The condition of the majority of patients was stable at time of presentation. The most frequent surgical intervention performed was intercostal tube placement. Thoracotomy was infrequently required and laparotomy for associated injuries was more common. Trends in the causes and epidemiology of thoracic trauma in an inner city environment over this 20-year period were noted: Blunt trauma, which is increasing in frequency, most commonly involves the younger age group and is usually related to automobile accidents. Penetrating injuries are generally seen in older patients within the pediatric age groups and are similar to those seen in the adult population.