Hemorrhagic shock is an emergency situation at high risk of morbidity and mortality in children. Diagnosis mainly relies upon physical examination and is usually easy in case of external bleeding but may be difficult in case of internal hemorrhage. The outcome widely depends on an early and effective treatment, starting on the scene (i.e. at the scene of an accident or home) and continuing during transport and on admission to the hospital. Management of hemorrhagic shock has recently been the subject of substantial changes with the emergence of the concept of damage control resuscitation. This concept, first described in adults, should also be applied to children taking into account some pediatric physiological particularities. The concept prioritizes short-term physiological recovery and is mainly based on resuscitative maneuvers targeting the lethal triad (coagulopathy—acidosis—hypothermia) in association with damage control surgery. The main steps of this strategy include: the use of a tourniquet and wound pressure to stop the bleeding, active rewarming, infusion of tranexamic acid and vasopressor, limited administration of crystalloids and colloids, together with activation of massive transfusion protocols. Definitive repair of injuries is performed hours or days later on a stabilized patient. The effectiveness of treatment is assessed based on the monitoring of conventional clinical parameters, including hemodynamic status and hourly urine output as well as biological parameters, such as lactate plasma concentration, acid-base balance, renal and liver function and coagulation test.