The pathology and sequelae of pediatric traumatic brain injury (TBI) differ from those of the adult TBI population. In childhood TBI, cognitive impairment and secondary delays are often overlooked in the referral and intervention process. Although TBI is the leading cause of acquired disability in childhood, most children with TBI are discharged from acute care to home with little or no rehabilitation. This literature review provides current information germane to the occupational therapist on sequelae and functional limitations that may exist or develop after TBI in children. Further, methods by which these deficits can be addressed within the context of Individuals With Disabilities Education Act guidelines are described. Children with a history of TBI should be screened regularly because some cognitive problems emerge years after the injury as developmental demands on the child increase. In this article, school-based therapists are urged to look beyond a child’s motor limitations to address the cognitive and neuropsychological problems typical of this population.