Blunt abdominal trauma is the number three cause of traumatic death in children over 1 year of age in the United States and the most common unrecognized fatal injury. Vague symptoms and nonverbal pediatric patients make effective triage difficult in this population. In addition, there is limited utility in abdominal ultrasound, and early laboratory results may be misleading in the diagnostic assessment. Often, this leads to unnecessary computed tomography (CT) imaging, which results in radiation exposure, cancer risk, and excessive cost to the family. It is important to risk-stratify the stable patients using a proven algorithm to guide clinical decision-making. This chapter discusses the diagnosis, management, and disposition of both stable and unstable pediatric patients presenting with blunt abdominal trauma.