Introduction: The complexity of TBI in the pediatric population is compounded by the dynamic nature of the developing brain, which responds differently to injury compared to the adult brain. Objectives: To assess the strategic decision-making in pediatric traumatic brain injury and leveraging repeat CT scans for enhanced treatment planning. Methodology:This randomized controlled trial (RCT) and a total of 324 patients were enrolled, with 162 patients assigned to each group. The sample size calculation was determined using appropriate power and effect size to ensure statistical reliability.Consecutive sampling was employed to recruit all eligible patients meeting the inclusion criteria until the desired sample size was reached. Results: Repeat CT scans led to significant treatment adjustments in the intervention group (45%) compared to the control group (18%, p < 0.001). GCS improvement was higher in the intervention group (mean increase of 3.5 vs. 2.1 points; p = 0.004), and complication rates were lower (15% vs. 25%; p = 0.02). The intervention group also had a shorter average hospital stay (8.2 vs. 10.4 days; p = 0.01). Mortality differences were not statistically significant (p = 0.14). Conclusion: It is concluded that scheduled repeat CT scans in pediatric TBI cases improve treatment planning by enabling timely adjustments, resulting in better neurological outcomes and shorter hospital stays.