Trauma is a leading cause of death in children in the United States, primarily due to motor vehicle accidents, firearm injuries, or falls. In 2015, for example, over 11,000 children and adolescents died from accidental trauma. Genitourinary (GU) trauma, however, is relatively uncommon. Despite its rarity, missed or improper management can lead to significant long-term complications. Pediatric GU trauma often presents initially to trauma centers, requiring adaptation of adult-focused protocols for children. Anatomical differences such as proportionally larger kidneys, higher-positioned bladders, and incompletely ossified pelvic bones predispose children to certain GU injuries. Additionally, their robust physiological reserve may mask early signs of hemodynamic instability, requiring heightened clinical suspicion. Management should focus on organ preservation, minimizing radiation exposure, and adjusting thresholds for imaging and interventions. This chapter provides practical guidelines for managing pediatric renal, ureteral, bladder, urethral, and external genital injuries, highlighting essential principles for general urologists managing pediatric cases.