Paediatric major trauma is rare and terrifying. Seriously injured children need good care but a number of factors (the relatively unusual presentations, their size, the way they communicate, their parents..!) make looking after them feel a lot harder than it really is. So what do clinicians really need to know to look after paediatric major trauma? We need to understand differences in physiological responses to injury (and how these can fox our triage assessments), differences in patterns and mechanisms of injury (and how these correspond to the way we diagnose, image and manage injuries in children) and how we can best prepare ourselves to make sure we look after these children well.