Although the sale of all-terrain vehicles (ATVs) to children under 16 years of age was prohibited in 1988, they continue to represent half of the ATV-associated injuries. We conducted a retrospective review of ATV injuries admitted to our institution from 1988 to 1998. We identified 76 patients over the last 10 years, with 50 patients admitted in the last 4 years. Children <16 years of age account for 50 per cent of all ATV-injured patients. Only eight per cent of these children wore helmets. We conclude that despite industry regulation, nearly half of ATV injuries continue to involve children under 16 years of age. The consent decree restricting access of children <16 years of age to ATVs has been ineffective and expired in April 1998. Significant morbidity and mortality continues to occur in children <16 years of age who operate these vehicles. Reform is needed, such as legislation that would mandate the sale of safety equipment on ATV purchase, as well as provide for ATV safety education.