The pediatric patient has unique anatomic and physiologic characteristics that influence injury patterns and the child's response to trauma. In order to effectively assess and manage the injured child, it is important to remember these key points: Children have less protective muscle and subcutaneous tissue, making them more vulnerable to internal injury. Children are predisposed to head injuries and TBI due to their large head:body ratio. Children have floppy and narrow airways and a higher laryngeal position, posing a challenge to the provider. They also have less respiratory reserve that can result in the rapid onset of hypoxia. Providers must recognize subtle signs of hypovolemia such as tachycardia and poor skin perfusion. A drop in a child's systolic blood pressure is a late and ominous sign. Young children have a poor ability to thermoregulate and a greater relative body surface area leading to hypothermia even in mild climates.