The psychological lesion of acute brain injury entails not only the specific consequences of neurological damage but also those of psychic trauma. These injuries are cataclysmic events that lead to a true post-traumatic stress disorder. They disable the child's capacity to cope with ordinary developmental challenges. The child often experiences difficulty integrating newly lowered adaptive capacities with prior identity as a masterful individual and may engage in disruptive, aggressive behavior as a defense against the narcissistic injury. The traumatic event is traumatic as well for the family, which must revise its own identity and aspirations to care for the disabled child. The treatment in such cases is multifaceted, requiring the responsible clinician's guidance and coordination to assure that it will coherently address the whole child and the family. The author illustrates this approach with a detailed presentation of the evaluation and treatment of a bright child who was damaged in an anesthesia accident during minor surgery before his fifth birthday.