Accidents cause more than half of all childhood deaths, despite early diagnosis and proper treatment. It has showed still high mortality and morbidity. We analyzed the results of treatment of 50 severely head injured children who were admitted to the department of neurosurgery. Wonkwang University Hospital from January, 1984 to March, 1988 and evaluated prognostic factors affecting the outcome. Our conclusions are as follow: 1) We experienced the high mortality in children no more than five years of age. 2) The Glasgow coma scale on admission was a reliable indicator predicting the outcome in severe head injury. 3) The neurological features such as papillary light reflex, oculocephalic reflex and motor respons were good indicators of outcome. 4) Therer was no significant difference in outcome between diffuse brain injury and intracranial mass lesion. 5) The diffuse brain swelling on brain CT scan worsened the outcome. 6) The mortality rate increased in children associated with viscus rupture in head inujury. 7) The overall outcome showed 38% of good recovery, 20% of moderate disability, 10% of severe disability, 4% of vegetative state, and 28% of death.