Traumatic acute compartment syndrome in childhood is a rare complication following an accident but it occurs more frequently than generally assumed. The accident mechanisms and anatomical localization are very well known so that this complication must always be considered if these risk factors are present. The diagnostic confirmation is based on clinical examination findings and implies the assessment of the three A′s: increasing anxiety, agitation and analgesic requirement. The measurement of compartment pressure can only be used if this examination is not possible or appears unsafe; however, there are no recognized age-adapted normal values. In the presence of manifest acute compartment syndrome, a timely dermatofasciotomy is the only treatment measure that results in a very good functional outcome. Otherwise, Volkmann’s ischemic contracture cannot be avoided.