Introduction. Over the past 50 years, the concept of treating spleen injuries has undergone significant changes from no alternative to splenectomy to conservative treatment, and this concept is still being actively discussed. The present review shows evolution of views and approaches to the diagnostics and treatment of spleen injuries in children.Material and methods. The literature search was done using keywords in eLIBRARY, MEDLINE and GOOGLESCHOLAR. 65 sources have been selected.Results. The modern concept of spleen injury care has been formed under constantly improving techniques of non-invasive imaging of injuries (ultrasound, computed tomography), under constantly developing endoscopic and endovascular surgical techniques. Currently, conservative treatment of spleen injuries is close to 90-95%.Conclusion. The evolution of views as to the treatment of spleen injuries in children is demonstrating fundamental changes which take place in traditional surgical practice as well as in medical technologies.