Purpose Pseudoaneurysm formation is a known complication following blunt liver and spleen injury (BLSI) in children. However, there is ongoing debate about the significance and need for screening and treatment. The purpose of this study is to review the incidence and management of pseudoaneurysms following BLSI in children. Methodology A retrospective review of BLSI at the sole, tertiary paediatric trauma centre in Western Australia was conducted. A systematic literature review of all articles from 2015-2025, reporting on paediatric traumatic splenic or hepatic pseudoaneurysms was performed. Results 232 patients with a mean age of 9.5 years were managed with BLSI. There was one mortality secondary to liver injury. Pseudoaneurysm was identified in 11 patients (5%), with eight diagnosed initially and three on delayed imaging. Eight were managed conservatively, and three with angioembolisation (AE). All cases achieved resolution. There were no cases of delayed haemorrhage. Systematic review revealed 160 cases of traumatic pseudoaneurysm in 7 studies. 25% were diagnosed initially and 60% on delayed imaging (15% unknown timing). 47% resolved without intervention, AE was performed in 52% and splenectomy in 1%. Delayed rupture was reported in 25 patients (1.2% of all BLSI). The majority of cases occurred at least one week after injury. However, most children with ‘delayed rupture’ did not require transfusion and there were no reported deaths. 23/25 underwent AE, two underwent splenectomy, and one resolved without intervention. Conclusions: Pseudoaneurysm formation post BLSI is uncommon in children. Delayed rupture is reported in 1.2% of cases in the literature, although there were no cases of death and the majority did not require transfusion. AE can be a safe and effective method for treatment of pseudoaneurysm and should be considered for symptomatic patients. However, the role for routine screening and prophylactic AE of asymptomatic children is less clear.