Over five years 415 children attended the accident and emergency department at Whakatane Hospital for injuries sustained while riding pedal cycles, four of whom died and 17% required admission to hospital. Twenty-eight percent of riders were less than eight years old, although it is known that children are not safe on roads up to this age. Forty-five children were passengers, mostly under five years of age and suffering from lower limb injuries from catching feet in wheel spokes. BMX bicycle riders were overrepresented among the injured. All deaths and permanent incapacity were a result of brain damage and could probably have been prevented by the use of approved safety helmets. There is a clear need for communities to address these safety issues.