Of pedestrian injuries that occur every year, approximately 50,000, including 1300 fatalities, are experienced by children between the ages of 1 and 14 years. Despite the importance of the problem, the pedestrian safety issue is often neglected in reports on vehicular injuries. Children between the ages of five and nine years, boys, and children in lower socioeconomic class are at higher risk of pedestrian injury than other children. Childhood pedestrian injuries take place predominantly in residential locations close to home and frequently occur while the child is at play. The risk of pedestrian injury to children is higher than that of other age groups when adjusted for traffic exposure, and a variety of developmental limitations may account for this fact. In spite of these limitations, children undertake collision avoidance maneuvers far more often than drivers do. Accident analyses have identified 15 different accident types, each reflecting a unique combination of human and environmental factors. Among children, the most frequently observed accident type is the midblock dart-out. Programs to modify pedestrian behavior, driver behavior, and vehicle design have met with modest success. In the United States, the cultural and political environments have not been favorable to the injury prevention effort. Urban designers and traffic engineers in Europe have undertaken a variety of modifications of the physical environment, and some of these have been successful in preventing pedestrian injuries to children.