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The commonest cause of death in children in developed countries is trauma, accounting for over 350 deaths/year in the UK. In children, about 75% of trauma occurs on the roads and the majority of these involve blunt trauma with most children sustaining multiple injuries. It is more common in boys (about two- to threefold) and in the summer. The age distribution is bimodal with peaks affecting toddlers and teenagers. Mortality and morbidity have been reduced by preventative strategies, for example traffic calming systems, road safety programmes, seat belts, better car design and bicycle helmets. Once injured, swift management by skilled staff in a trauma network gives the best results and key to this are care in transport, and recognition and management of the injuries and finally rehabilitation. Important strategies for major trauma include what has become known as ‘damage limitation surgery’. In children, the absence of a plausible mechanism of injury should raise the suspicion of child abuse, and a plausible mechanism but an unusual situation might suggest neglect (e.g. a skate board injury in an 8-year-old at 23:00 hours).