Significant advances have been made in the past quarter century relative to the management of pediatric craniofacial trauma. The recognition of salient differences between children and adults is paramount in craniomaxillofacial reconstructive efforts. Proliferation of trends toward open reduction of craniofacial fractures, primary cranial bone grafting, when indicated, and more liberal use of micro- and miniplates, requires careful consideration. Success can be measured only after long-term follow-up over decades. Various anatomic, social, environmental, economic, and cooperative issues come into play in the contemporary management of pediatric craniofacial injuries.