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Pediatric patients have unique anatomy and physiology that account for differences in injury patterns when compared to adult patients. These differences warrant special consideration in injury recognition and intraoperative management. The initial management of pediatric thoracic trauma should follow the principles of the primary survey in that life-threatening injuries should be ruled out. Hemodynamically unstable patients with serious thoracic injury warrant thoracotomy for expeditious management of life-threatening conditions. However, the management of hemodynamically stable patients with thoracic injury has evolved with the advent of minimally invasive surgery and the well-documented benefits of video-assisted thoracoscopic surgery (VATS) compared to traditional thoracotomy. Multiple studies have shown that VATS can be performed safely and effectively for traumatic injuries in children in both the acute and delayed setting. 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