Over a 12-year period, 463 children under 13 years of age were treated for perineal injuries. The most common cause of injury was a fall astride, but motor vehicle trauma and rape were responsible for most of the severe and multiple injuries. Physical or sexual abuse was evident in 178 (38 per cent) of children, and four sustained injuries from forceful enema. Minor abrasions or first degree tears (88 per cent) and second degree tears (6 per cent) were sutured primarily or allowed to granulate with sepsis rates of 1.2 per cent and 14 per cent respectively. Twenty-nine (6 per cent) children sustained third degree lacerations; one died from secondary pelvic haemorrhage. In the 28 survivors, the outcome of primary (18) or delayed (ten) surgical repair was related to whether or not early defunctioning colostomy had been performed.