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The injury risks to children who ride all-terrain vehicles (ATVs) are well documented and include increased risk of death or hospitalization. We identify pediatric hospitalization trends for ATV injuries, provide national benchmarks, and discuss policy and prevention implications.We used data (1997–2006) from the kid's inpatient database, the only all-payer inpatient care database for children in the United States. Children and adolescents aged 0 year to 17 years were included. We generate national estimates of hospitalizations.Total pediatric hospitalizations for ATV injuries have increased 150% from an estimated 1,618 in 1997 to 4,039 in 2006. The overall ATV-related injury hospitalization rate increased 139% from 2.3 per 100,000 in 1997 to 5.5 per 100,000 in 2006. Rates increased for both males and females, although the rate for males remained much larger than for females in 2006 (8.1 per 100,000 vs. 2.7 per 100,000, p < 0.001). For all age groups, ATV hospitalizations increased significantly between 1997 and 2006, but this change was most pronounced among those aged 15 years to 17 years. ATV hospitalization rates also increased significantly for patients hospitalized with traumatic brain injuries.ATVs are associated with a significant and increasing number of hospitalizations for children. Reexamination of previous federal policies, including the potential for a new consent decree between the Consumer Product Safety Commission and ATV industry representatives, should be considered to address this alarming trend and to adopt effective strategies to minimize the use by children. Enforceable state-level policy to promote helmet use among ATV riders seems to be critically needed.