Traumatic brain injuries are the leading causes of morbidity and mortality in children, most frequently caused by car crushes and accidental falls. The treatment focuses on limiting the primary lesions and minimizing secondary lesions; haemorrhagic shock may rapidly occur in infants and young children. A Paediatric Glasgow Come Score lower than 9 points suggests a severe brain injury, therefore accurate and rapid clinical and neuro-imagistic diagnosis is the key of success. The extradural hematoma and scalp hematoma are sufficient enough to produce anaemia and shock as the total blood volume is lower in infants. So they need early surgical intervention for extradural hematoma and blood volume replacement. Tight dural closure is the key step in surgical management. Duraplasty can be done with a patch of pericranium / periosteum. Cranioplasty is not indicated in infants. The Paediatric Neurosurgical Department and Paediatric Intensive Care Unit represent also a vital necessity, as long time follow–up is mandatory.