Missed fractures and other occult musculoskeletal injuries are common in paediatric trauma patients despite the thorough evaluation with standard trauma protocols. Several factors have been identified that contribute to the risk of failing to identify these injuries during the initial resuscitation and assessment of the paediatric trauma patient. These include patient-related, clinical, technical, and radiological causes. Preventive strategies have been proposed to minimize these overlooked injuries and their potential long-term consequences. A timely review of this problem is appropriate to continually improve the quality of care delivered to paediatric trauma patients.