Pelvic injuries in children are most commonly due to motor vehicle and pedestrian accidents. Pelvic trauma should be viewed as a sign of significan force and associated multi-system injury should be suspected. Signs of pelvic injury include tenderness, instability and crepitations of the pelvis and hematoma of the perineum, scrotum or proximal thigh. Injury to the pelvis can result in a great deal of blood loss. Assess the genitalia for swelling, bruising, lacerations. Blood in the diaper or at the urethral meatus suggest genitourinary injury. Priapism can be a sign of spinal cord injury. Examination of the perineum is necessary and can also be sensitive. Make sure to explain to the caregiver and the patient what you are about to do and why it is important.