Traumatic brain injury (TBI) is a significant health issue in children and young adults. Although most TBIs tend to be mild or moderate, TBI is a leading cause of death or disability in children, accounting for a quarter to one third of childhood accidental deaths (Parslow et al, 2005; Durkin et al, 1998). Data suggest incidence rates of 100–300 per 100 000 children (British Society for Rehabilitation Medicine, 1998; Hawley et al, 2003). However, rates as high as 1000–3000 per 100 000 children per year have been reported (McKinlay et al, 2008). Boys are at greater risk of TBI compared to girls, and the risk of TBI increases with age (Rivara, 1982; McKinlay et al, 2008). Evidence also suggests that children who have sustained a TBI are at increased risk of sustaining a subsequent TBI (Swaine et al, 2007). Following assessment the majority of children can be managed without admission to hospital (Swann and Teasdale, 1999). Peak attendance at A&E occurs during the winter when shorter daylight hours increases the risk of accidents and during school holidays when children are more likely to be playing outside (Parslow et al 2005). This article will outline the initial stabilisation of a child who has sustained a TBI and the principles of pre-hospital management. In addition, the role of the school nurse in relation to the identification of TBI and accident prevention will be discussed.