Abstract Acquired brain injury in childhood is not uncommon and arises from trauma, metabolic conditions, CNS tumours and infection, toxins or as a result of treatment. Injury to the brain can occur any time from just after conception onwards. Age of injury is a critical variable in determining outcome, as is the mechanism of injury. When the brain is in a period of rapid growth, injury can have greater effects than when the brain and associated functioning have slowed or are fully developed. Injury in younger children generally leads to greater and more global deficits, with evidence of some functional reorganization, but only when injury is focal. Some functional outcomes emerge with age, often years after injury. Apart from functional problems, social, educational and self-image difficulties can arise from physical impairments. In addition, there can be cognitive problems with speed of processing, attention, memory, language and communication, visual perception and executive skills. Few children have problems in all these domains. Effects can be cumulative and interact. Frequently there are behavioural and emotional sequelae, such as disinhibition, impulsiveness, depression and anxiety, often more difficult for parents to cope with than physical or cognitive problems. Difficulties can arise directly from the child's reaction to the injury and sequelae, parental management and education's failure to meet special needs. The effect on the family can be considerable, and after initial involvement from health and education, families find help and support decreases with time. Thorough assessment is the first step in a range of psychological interventions.