Polytrauma in children is rare, however trauma is a leading cause of death in children. Clinicians with responsibility for management of the child suffering major trauma must recognize the conflict between these facts. Simulation and preparation can help to improve the quality of care at both individual and institutional levels. Children are not small adults, and their anatomical and physiological differences manifest themselves in different responses to major trauma than those seen in adults. This reality should be met with a tailored approach to assessment, investigation and management that accommodates the changes occurring from infancy, through childhood and adolescence to adulthood. This approach minimizes the risk of harm from inappropriate irradiation or intervention. Children have remarkable resilience and can make dramatic recoveries from seemingly irrecoverable situations. The comprehensive treatment of musculoskeletal injuries should therefore not be compromised in the setting of polytrauma, and attention must be given to the optimal time for treatment. Damage control resuscitation and early appropriate care facilitate an individualized response. Outcomes for paediatric polytrauma are improved by management in a specialist centre, with early aggressive management of injuries that require surgical treatment by an experienced multidisciplinary team.