Acute liver failure is a severe and sudden onset of hepatocyte dysfunction, leading on to synthetic and detoxification failure, which could progress to multi-organ failure and death. Common causes vary with age and geographical location. Metabolic liver diseases are frequent in the young child, sometimes amenable to a specific treatment or prenatal diagnosis. In older children, viruses, toxics, metabolic diseases (especially Wilson), autoimmune hepatitis are the main causes. Management should be initiated in conjunction with investigations, as soon as liver failure is diagnosed. The patients should be early transferred to an expert centre, where complications can be prevented and liver transplantation is possible. Improved intensive care management and availability of donor organs (split livers or living-related donors) has made it possible to transplant young children, and improved their survival chances.