Fractures are common during childhood; however, they can also be the presenting symptom of primary or secondary causes of bone fragility. The challenge is to identify those children who warrant further investigation. In children who present with multiple fractures that are not commonly associated with mild to moderate trauma or whose fracture count is greater than what is typically seen for their age, an initial evaluation, including history, physical examination, biochemistry, and spinal radiography, should be performed. In children with bone pain or evidence of more significant bone fragility, referral for specialist evaluation and consideration of pharmacologic treatment may be warranted.