Trauma is the leading cause of death and disability in children over the age of 1 year. As a member of the paediatric trauma team, the anaesthetist performs a key role in the assessment, stabilization and urgent management of the injured child. This article describes the key principles of the primary and secondary survey as applied to paediatric trauma, including a discussion of the relevant paediatric anatomy and physiology that underpins the differences in injury pattern and management compared to adults. Paediatric traumatic cardiac arrest management focuses on the correction of hypoxia, haemorrhage, tension pneumothorax and cardiac tamponade as potential reversible causes. Traumatic brain injury is the most common severe injury in children and early correction of key physiological parameters can reduce the development of secondary injury. Intra-abdominal haemorrhage may necessitate damage control laparotomy. Burns are more common in children than adults and can pose significant challenges to the anaesthetist if a facial/airway burn or inhalational injury is present. Prompt fluid and analgesia management of these children can optimize their outcomes. Finally, we discuss pain management, suspected physical abuse and death in relation to paediatric trauma.