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Metacognition is a difficult concept to grasp in children because it is so dependent on lived experiences and the knowledge constructed as a result. Current models suggest a slow development of metacognition. Brain lesions could slow down this development even more. In this sense, metacognitive rehabilitation in children with brain injury is clinically attractive. The application of such methods to children seems feasible, as was the case with Sam, a young boy of 10 years and 3 months who presented a hemorrhagic stroke. For 9 months, he was taught problem-solving strategies aimed at reducing his impulsivity and improving his attention span and mental flexibility. An improvement in standardized test scores is visible after treatment. However, the question of the effects of the treatment remains unresolved and lacks validity today, due to methodological difficulties. Factors such as spontaneous recovery, parental involvement, motivation, and recurrence of the lesion could explain the effects observed on test performance.