Trauma is the leading cause of death in children older than 1 year of age and blunt trauma is the most common mechanism. The spleen and liver account for approximately 70% of all visceral injuries caused by blunt trauma, by far the most commonly injured intra-abdominal organs.1 Injury severity of spleen and liver injury is graded by the American Association for the Surgery of Trauma injury scoring scale and is shown in ►Tables 1 and 2. The primary goals after blunt splenic or hepatic injury are patient stabilization and organ function preservation. Over the last 50 years, the standard of care for spleen and liver injuries has shifted to nonoperative management. Guidelines for management of the spleen and liver trauma have been proposed.2 Modifications and challenges to this protocol have certainly been made. A review of current evidence is presented here to show current strategies for diagnosis and management of blunt hepatic and splenic trauma in the pediatric population.