Purpose of Review <p>The purpose of this review is to understand the indications for resuscitative thoracotomy in pediatric trauma and review the steps to performing a resuscitative thoracotomy. This review will also discuss the potential emotional and mental health effects on the team after such traumatic experiences in children.</p> Recent Findings <p>As more data have been collected about pediatric resuscitative thoracotomy outcomes, recent studies have suggested that indications should differ from those in adults. In comparison to adults, the different physiologic responses in pediatric trauma patients have demonstrated worse outcomes for patients arriving without signs of life.</p> Summary <p>Pediatric trauma patients have distinct physiology from adults and require a unique set of considerations when deciding whether to perform a resuscitative thoracotomy. Trauma providers should understand both the risks and benefits of different resuscitative adjuncts, as well as the potential risks to the trauma team and how to mitigate these.</p>