Thoracolumbar spine injuries are uncommon in pediatric patients. Distinctive anatomic and biomechanical features of the pediatric spine increase its susceptibility to unique patterns of injury. Motor vehicle accidents account for most thoracolumbar injuries, and because these injuries are commonly associated with other systemic injuries, a multidisciplinary approach to their treatment is often necessary. Although clinical examination can alert the physician to a thoracolumbar injury, it can be unreliable in younger patients, requiring a greater reliance on advanced imaging methods for both screening and diagnosis. Considering their significant ability to heal, most pediatric thoracolumbar injuries can be managed nonsurgically. Overall, with the exception of injuries causing significant neurologic deficits, good outcomes can generally be expected with treatment.