Accidents are the most common cause of death in children over one year of age. Prevention remains a high priority. We have reviewed the current epidemiology of childhood accidents and their prevention, and made recommendations for the future. In 1992, 559 children died in United Kingdom as a result of an accidents--240 from road traffic accidents and 100 from burns and scalds. Every year 50 children drown. Accidents cause significant disability to children. Many children, up to one in four of the population in urban areas, attend accident and emergency departments, and 5-10% of these are admitted to hospital. Accident risk factors include low social class, psychosocial stress, an unsafe environment, and child developmental disorders. Research has shown that prevention is best achieved by making the child's environment safer, often through legislation. Insufficient resources have been put into both research into childhood injuries and preventive work in communities. Collaboration between health authorities, NHS trusts, local authorities and community networks is vital if success is to be achieved. A national safety agenda for children would focus the attention that this problem deserves.