Two cases are reported that reiterate the significance of pediatric seat belt usage. Detection of associated injuries is difficult and often delayed. The presence of intra-abdominal free fluid on CT without solid organ injury should indicate the need for surgical intervention. Diagnostic peritoneal lavage usage in pediatric seat belt trauma may need to be re-evaluated. These cases emphasize the above as well as important postinjury clinical changes necessary for earlier diagnosis. A newly designed youth seat belt is presented to help prevent these injuries.