There is good evidence for therapeutic hypothermia as neuroprotective treatment in perinatal asphyxia and in cardiac arrest in adults. However, to date, there is no evidence in paediatric traumatic brain injury (TBI). A meta-analysis of four randomised controlled trials of hypothermia in severe paediatric TBI revealed a nonsignificant higher risk of mortality with hypothermia (risk ratio 1.45, 95% confidence interval 0.71–2.94). These patients should be kept normothermic (36–37°C). Hypothermia may be occasionally used to lower increased intracranial pressure, but arterial hypotension in the rewarming period must be avoided.