Recognition and management of hemorrhagic shock early after injury is needed to improve survival and functional outcomes among children and adults. Because of robust physiological compensatory mechanisms that maintain perfusion, recognition of shock can be more difficult in children compared to adults, contributing to delayed management until later stages of shock. Despite several studies in adult patients showing that clinical judgment alone has poor performance, trauma surgeons primarily use clinical gestalt to identify hemorrhage and decide when to intervene. Several hemorrhage scoring systems have been developed to address this issue and assist clinicians in recognizing the subtle characteristics associated with early hemorrhagic shock. In this review, we identified and analyzed the performance of eight pediatric scoring systems, the initial heart rate upon arrival, and the arrival systolic blood pressure as predictors of the likelihood of transfusion within 6 h after hospital arrival. These scoring systems and physiological values have inadequate performance to be used alone for identifying children who may need any amount of transfusion within 6 h of hospital arrival. Hemorrhage scoring systems may best be used as an adjunct to clinical judgment but warrant further investigation before used for this purpose.