Pulmonary and Respiratory Trauma in Infants and Children: A State-of-the-Art Review of Mechanisms, Diagnosis, Contemporary Management, and Outcomes

Background Pulmonary and respiratory trauma remains a major cause of morbidity and mortality in infants and children worldwide. Although blunt thoracic trauma accounts for most injuries, important causes include birth-related trauma, ventilator-associated barotrauma, child abuse, penetrating injuries, blast injuries, aviation disasters, and iatrogenic complications. Unique anatomical and physiological characteristics of children result in injury patterns that differ substantially from those observed in adults. Objective To review the epidemiology, mechanisms, pathophysiology, diagnosis, imaging, contemporary management, and long-term outcomes of pulmonary and respiratory trauma in infants and children. Data Sources A narrative review of contemporary literature indexed in PubMed, Scopus, Embase, and major pediatric trauma, respiratory, and critical care journals published between 2020 and 2026. Results Pulmonary contusion remains the most common pediatric thoracic injury and frequently occurs in the absence of rib fractures owing to increased chest wall compliance. Advances in trauma imaging, point-of-care ultrasonography, low-dose computed tomography, bronchoscopy, thoracoscopy, and extracorporeal membrane oxygenation have significantly improved diagnostic accuracy and clinical outcomes. Ventilator-induced lung injury, child abuse-related thoracic trauma, blast injury, and iatrogenic respiratory trauma continue to present major management challenges. Contemporary care increasingly emphasizes multidisciplinary management, lung-protective ventilation, minimally invasive intervention, and individualized treatment strategies. Conclusions Early recognition, appropriate imaging, and multidisciplinary management are critical for optimizing outcomes following pediatric pulmonary trauma. Emerging technologies including artificial intelligence-assisted imaging, advanced ventilatory monitoring, and international pediatric trauma registries are expected to further improve diagnosis and evidence-based care.