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Penetrating Neck Injuries (PNI) are uncommon in the pediatric population, but they constitute a significant management challenge. Literature has been scant regarding the evaluation and treatment of such injuries in children. Our objective is to evaluate if physical examination alone is sufficient in the assessment and management of pediatric PNI.Retrospective chart review.Pediatric emergency center of an urban emergency department (ED) and level 1 trauma center (TC).All patients 16 years or younger that had penetrating neck injuries between January 1995 and June 2000.None.During the study period, a total of 148,000 and 9900 patients were seen in the pediatric ED and the TC, respectively. Thirty-one children (22 males, 9 females) with PNI were identified. The median age was 9.5 years (range of 10 months to 16 years). Most children (81%) with PNI were evaluated in the TC. Motor vehicle crashes accounted for 32% of PNI and gun shot wounds for 23% of cases. Most PNI (84%) occurred in zone II of the neck. Eight patients underwent surgical exploration (25.8%) for platysmal penetration, none of which revealed any vascular injuries. Only 4 patients had barium swallows performed based on physical examination findings. All barium swallows were normal. There were no angiograms performed during the study period. A total of 3 patients died (mortality rate of 9%), all of which had major physical examination findings.PNI are infrequent in the pediatric population. Most of the patients in our review presented with minor physical examination findings and did not require exploration or diagnostic studies. Observation of the stable child in our case series was found to be an acceptable choice of management of PNI. Further prospective studies are needed to validate these results.