Introduction. Children who have suffered brain damage form a large group of patients in need of rehabilitation. For rehabilitation, patients require not only surgical, neurosurgical, traumatological, pharmacological and other medical support, but also the creation of special conditions for psychiatric care, psychological and pedagogical correction of their psychophysical potential. Neurological, motor and mental consequences of severe injuries of the nervous system in children lead to a high degree of disability with a subsequent restriction of their life, where social maladaptation and a violation of the quality of life are the primary problems. An integrated approach with differentiated qualified help will increase the effectiveness of rehabilitation programs and help the children adapt when they return to their normal environment. Aim of this study was to identify the characteristics of mental activity during the recovery of the level of consciousness in children after acute severe brain damage at an early stage of rehabilitation. Materials and methods. We examined 210 children under the age of 18 years with severe brain damage (traumatic brain injury, hypoxia, hydrocephalus) who were admitted for treatment and rehabilitation. Clinical-psychopathological, pedagogical methods were used for examination as well as diagnostic scales, questionnaires. Results. The main differentiating signs were divided into three groups, depending on the mental activity of the child, the level of consciousness: Group 1 — 37 (18%) patients with mental activity with physical, cognitive and social abilities with the minimal «+» consciousness (a–/hyperkinetic mutism with emotional reactions, understanding of speech); 2-nd group — 67 (32%) patients with dominant manifestations of physical and cognitive abilities with the minimal «–» consciousness (a-/hyperkinetic mutism without emotional manifestations and understanding of speech); 3rd group — 106 (50%) children with a weak manifestation of mental activity (physical abilities) in a vegetative status/exit from a vegetative status. Conclusion. Three variants of mental activity in children after acute severe brain injuries were distinguished — from minimal involuntary reactions or their absence during the vegetative status/exit from the vegetative status to arbitrary actions according to the instructions of an adult with a minimum «+» consciousness. Understanding the dynamics of the recovery of children’s mental activity after neurotrauma may make it possible to have a differentiated approach to psychiatric, psychological and pedagogical rehabilitation in order to correct the recovery of mental functions in pediatric patients, and to prevent the developmental disorders as the child grows.