High early strength (HES) concrete patching materials are increasingly used to repair damaged pavements. The use of HES concrete enables the repaired pavement to be opened to traffic shortly after the repair has been installed; for example, opening pavements to traffic 4–6 h after the concrete is placed is becoming more common. HES concrete mixtures are typically designed with a low water-to-cement ratio and a high cement content; they contain accelerating admixtures and limited supplementary cementitious materials. As a result, these HES patches may be susceptible to self-desiccation, causing autogenous shrinkage and early age cracking. Self-desiccation can lead to reduced hydration, limited strength gain, and overestimation of strength development in maturity-based predictions. The objectives of this study are threefold. First, the paper will illustrate how self-desiccation can lead to the premature cessation of hydration and increased potential for shrinkage cracking. Second, the paper will illustrate how maturity-based predictions can be modified to account for self-desiccation. Third, internal curing is discussed as a way to mitigate self-desiccation and shrinkage ultimately improving the performance of HES concrete patching materials.