Clinicians working in the acute care setting will certainly encounter many pediatric patients who have been injured. Injury remains the most common cause of death and disability for pediatric patients. Motor-vehicle-related injury events still rate as the most common cause of death for children across all age groups. In a recent joint policy statement endorsed by more than 20 organizations representing a variety of disciplines, guidelines for the care of children presenting for care in an emergency department (ED) setting were outlined. Although the guidelines do not outline specific details for the care of injured children in regard to testing, the guidelines certainly emphasize monitoring the overall care provided, with mechanisms in place for quality improvement to take place. Specifically, physicians who staff the ED are encouraged to have "the necessary skill, knowledge, and training in emergency evaluation and treatment of children of all ages who may be brought to the ED consistent with the services provided by the hospital." This expectation applies not only to physicians, but also to nurses and other ED healthcare providers. This review article is intended to address specific controversial areas, including both the initial evaluation and treatment decisions regarding the acutely injured child. Specific areas to be covered include personnel providing care for the pediatric patient, the appropriate use of imaging tests, and the appropriate use of laboratory testing. As more is learned about the unique aspects of pediatric trauma patients, guidelines for evaluation and treatment should be modified to strike the balance between the many factors involved in identifying injuries with minimization of risk to the patient and potential side effects of the diagnostic testing. [ABSTRACT FROM AUTHOR]