Cardiac injuries occur infrequently in children. Although the mechanisms of injury are not unique to the pediatric age group, the frequency of the various injuries is quite different. This unusual nature dictates an enhanced awareness for proper management. Twenty cases were recognized in a 16-year retrospective review. There were six children with perforations from cardiac catheterizations, ten children with penetrating injuries, and four children with blunt injuries. Two of the children with blunt injuries presented as myocardial contusion and one child survived blunt rupture of the right atrium. Only one death occurred in the series—a newborn baby who died from an unrecognized cardiac tamponade secondary to perforation of the right ventricle during catheterization. The diagnosis and special techniques for management of injuries due to catheter perforation and blunt injuries of the heart in infants and children are discussed.