During the past 20 years, there have been significant advances in the treatment of acute head injury in children. Major factors responsible for the advances have been the recognition of the damaging effects of hypoxia and hypercapnia, the prompt airway intubation and ventilatory support, the more readily available pediatric critical care support, the easy access to computed tomography, and the continuous monitoring and control of intracranial pressure. The outcome of pediatric moderately severe and severe head trauma is noted to be favorable in most modern reports. However, the outcome of erately severe and severe brain insults secondary to nonaccidental trauma has been very poor. This is probably due to delayed access to medical care and severe hypoxic-ischemic injury.