Peripheral nerve injuries resulting in significant neural disruption frequently present complex management challenges. Typically the product of fracture, dislocation, or crush injuries, pediatric peripheral nerve injuries may be difficult to accurately characterize. Thorough clinical examination coupled with electromyogram and neurophysiologic studies are extremely useful. When possible, primary repair should be attempted. If, however, defect size precludes primary reanastomosis, use of a nerve graft may be advantageous. Alternatively, nerve conduits, such as veins, pseudosheaths, and bioabsorbable tubes, are also effective facilitators of nerve regeneration. Although nerve injuries of the pediatric hand often present complex challenges, a thorough knowledge of diagnostic methods and advances in surgical interventions offers better outcomes.