Though chest trauma in children is not so common as it is in adults, it may be life-threatening and suggest a high mortality. Herein we retrospected 59 cases of severe chest trauma of children out of 1506 chest trauma cases during 1986-2006 in our department. Features including demographic characteristics, causes, injury types, associated wound had been collected. There were 42 males (71.18%), 17 females (28.82%), 30 cases (50.84%) in the former 10 years and 29 cases (49.16%) in the latter 10 years. The incidence of children's severe chest trauma was 4.9% and 3.2%, respectively, averagely 3.9%. In these 59 cases, 46 cases were treated conservatively, 13 cases were treated by surgery. Four patients died, two in operations, the others attributed to ARDS and cardiac arrest, respectively. The cure rate was 93.22%. Statistic method was used to compare between two groups and with published results in the literature. Children's severe chest trauma is characteristic and different from adults. In our experience, accurate diagnoses and intensive care are very important to save their lives.