This chapter discusses pediatric facial trauma, where high-impact injuries from motor vehicle accidents are the most common cause of pediatric facial fractures. Other causes include interpersonal violence, falls, and sports-related injuries. The pediatric facial skeleton is less vulnerable to injury than that of the adult due to a number of characteristics. As the craniofacial structures undergo developmental changes during childhood, the incidence and pattern of traumatic injuries also changes. A primary survey assessing airway, breathing, circulation, disability, and exposure is warranted with special consideration given to the high surface-to-volume ratio, metabolic rate, low total blood volume, sensitivity to airway edema, and high oxygen requirements that can lead to rapid decompensation in pediatric patients. Traumatic injuries to the bones of the midface include fractures of the orbits, zygomaticomaxillary complex, and nasal bones, as well as naso-orbito-ethmoid and LeFort fractures.