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Pediatric TBI is common all over the world including India. It is associated with mortality and long tenn morbidity; especially at risk are boys, aged 1-4 years. Children are quite different from adult in tenn of anatomy physiology and psychological effect of TBI. TBI in children is often diffuse, having more cerebral edema and raised ICP as compared to adult. Most common cause of pediatric TBI is fall. Most of the TBI related fatalities are due to motor vehicle injury First step of management is evaluation and stabilization of life-threatening condition. So, stabilization of airway and cervical spine, breathing and assisted ventilation, circulation and maintenance of cerebral perfusion pressine and control of active bleeding are important stabilization steps. After stabilization one should get details history and examination to assess the trauma severity. A noncontrast CT head should be obtained before shifting to PICU. The goal of intensive care management is to maintain cerebral perfusion pressure, decreased ICP and prevent further cerebral. Neurointensive care includes monitoring and treatment of raised ICP and seizure, and removal of mass effect by neurosurgeryeons. There are pediatric TBI guideline given in 2012 and many review articles by anestheticsfrom anesthesia perspective. The objective of this review is to give a practical overview of pathophysiology and management of severe TBI for pediatric intensivist.