Trauma care is one of the major components of modern surgery. This is especially true of pediatric surgery, because injuries are by far the leading cause of death for children from early childhood through adolescence. Recently, the epidemiological model of host, agent, and environment has been applied to the study of childhood injuries to increase understanding of their causes and to provide a basis for primary and secondary prevention strategies. We now know that injury patterns vary with age, sex, race, place of residence, and family income, and that the rates of fatal injury from violence, whether interpersonal or self inflicted, are increasing. We also know that firearms are involved in an ever-increasing proportion of cases. As trauma care has improved, the key to further reductions in the toll of injuries on our children is prevention.