On September 17, 2024, a coordinated detonation of approximately 5,000 pager devices in Lebanon produced a large mass-casualty incident. Devices contained pentaerythritol tetranitrate (PETN). We report 5 pediatric patients transferred to a tertiary referral center for management of complex multisystem injuries.

We performed a brief report of 5 children (<12 years) referred to Baqiyatallah Hospital, Tehran. Demographics, injury pattern, surgical interventions, and short-term outcomes (up to 3 months) were abstracted from medical records. All patients received multidisciplinary care (ophthalmology, plastic surgery, orthopedics, otolaryngology, pediatrics, infectious disease).

Mean age was 9.2 years (range 5–11). All 5 children sustained ocular, facial, and hand injuries. Three eyes were auto-eviscerated, and 4 children underwent partial hand amputations. Multiple operative procedures were required per patient (ocular surgery, facial reconstruction, orthopedic fixation). Early outcomes were poor for vision and hand function in the majority; reconstructive planning and prosthetic rehabilitation were anticipated for longer-term care.

Close-range exposure to small PETN-containing devices produced a distinctive pediatric injury pattern dominated by severe ocular and upper-extremity trauma. These findings emphasize the need for pediatric-focused acute care algorithms and sustained rehabilitation resources after blast incidents.