Purpose: The purpose of this study was to determine the contribution of blunt vascular trauma to death and disability in children. Methods: We reviewed the medical records of 41 patients aged 17 years and younger requiring operative intervention for 48 blunt vascular injuries during the past 18 years. Results: Eight patients had arterial injuries (seven brachial, one superficial femoral) associated with orthopedic trauma resulting from falls. All eight were associated with a pulse deficit and were easily recognized. None of the eight had late sequelae after vascular repair. Thirty-three patients had vascular trauma as a result of motor vehicle crashes (n = 17), motor vehicle/pedestrian accidents (n = 12), or severe crush injuries (n = 4). Twenty-one (64%) were admitted in shock. Twenty-one major abdominal venous injuries were present in 17 patients and were lethal in 11 (65%). Abdominal venous injuries were not recognized before laparotomy. Nine of the 33 (27%) patients had extremity vascular injuries associated with orthopedic trauma, and three (9%) had major injuries of thoracic vessels. Only three patients had major abdominal arterial injuries in this series. Conclusions: Vascular injuries resulting from blunt trauma are rare in the pediatric age group. Whereas blunt arterial injuries associated with long bone fractures are readily recognized, easily treated, and result in minimal late morbidity, blunt abdominal venous injuries are rarely recognized before exploration and are lethal in more than half. Devastating venous injuries are more common than arterial injuries after blunt abdominal trauma in children.