Pediatric vessel injuries are rare and associated with high mortality and morbidity. This is owed to the distinct anatomical and physiological features in children, which are significantly different from those in adults. Their smaller, spastic and more fragile vessels predispose to vascular occlusion and cause a lower injury threshold. Due to the tendency of children’s vessels to go into vasospasm upon trauma, the severity of injury might get concealed and lead to non-recognition. Furthermore, despite possessing a larger neoangiogenic potential, which accounts for the good tissue viability seen in pediatric patients following reconstructions, children are more sensitive to chronic ischemia, since it can give rise to limb-length discrepancies as the child grows. There are several complications that could arise from vessel injuries in children, ranging from arteriovenous fistulas, pseudoaneurysms, vessel occlusions, to compartment syndrome and limb loss. The diagnosis and treatment of each of these complications, depend on the mechanism, location and severity of injury, as well as other factors, i.e. the age of the patient. The fast and efficient management of pediatric vessel injuries is further complicated by the lack of training and experience of surgeons regarding these specific cases. One of the main areas of interest for research in the field of pediatric vascular surgery, is the development of tissue-engineered vascular grafts that are able to grow with the child and circumvent the downsides connected to autologous and synthetic grafts.