Background: Pediatric mortality from combat-related injury exceeds adult mortality despite similar illness severity. This study aims to provide a comprehensive analysis of injury patterns and resource utilization for children affected by combat. Understanding pediatric-specific injury patterns, in relation to survivability, will inform training and resource needs in future conflicts. Methods: We conducted a retrospective cohort analysis of the Department of Defense Trauma Registry. Inclusion criteria were children < 17 years of age, with a conflict-related injury, who were treated at a deployed military treatment facility from 2001 to 2022. Patient demographics, mechanism of injury, procedures, complications, and outcomes were categorized. Results: There were 5,680 pediatric casualties with a conflict-related injury and discharge status. The mortality rate was 9.4%. Those that did not survive to hospital discharge had a higher illness severity score (25 vs 9, p <0.001), sustained a burn injury (18% vs 9.4%, p < 0.001), were younger, and had greater median [IQR] blood loss (12.1 [3.6, 24.8] mL/kg vs 2.9 [1.2, 8.3] mL/kg, p < 0.001). Acute respiratory failure was increased by 4.6-fold (2.3% vs 0.5%, p < 0.001) and fluid and electrolyte imbalances were increased by 2.3-fold (6.8% vs. 2.9%, p < 0.001). Conclusion: This is the largest epidemiologic study of children injured in conflict and the first to characterize injury patterns and resource utilization through a mortality lens. Without autopsy data, it is impossible to say what injuries were potentially survivable, but this study provides key insights into the complex injury patterns and complications resulting in conflict-related death. It provides integral information for pediatric training and resource needs in order to prepare the warfighter for the next conflict.