The seat belt sign is a cutaneous injury caused by a restraint during deceleration. The presence of a seat belt sign during physical exam was correlated with computed tomography findings and the presence of a blunt intestinal injury requiring operative intervention. A retrospective study of the hospital's trauma registry revealed seven pediatric patients who presented with a documented seat belt sign over a five-year period. Five of the six patients received preoperative CT scans of the abdomen and pelvis. Four of the five CT scans bad positive findings consistent with a blunt intestinal injury. Six of the seven patients bad blunt intestinal injury at laparotomy. Children presenting with a seat belt sign and positive CT scan findings of the abdomen should be considered for early exploratory laparotomy.