Coma in the pediatric patient is a medical emergency and must be dealt with in a rapid, organized way. Basic life support needs, evaluation of history, and physical examination are all of paramount importance and evaluation of these three critical areas must proceed simultaneously. Specific diagnoses must be treated appropriately, but there are key general principals to coma management that must be dealt with sequentially. The outcome in childhood coma is substantially better than adult coma, and in many cases is determined by speed and appropriateness of intervention.