All terrain vehicles (ATVs) have been associated with death and serious injury since their introduction into the marketplace. Fifteen cases of ATV-related brain and spinal cord injury reported to the Louisiana Central Nervous System Registry during 1995 were evaluated for severity, etiology, and outcome. Eleven (73%) of these injuries were sustained by persons under 18 years of age. Despite US Consumer Product Safety Commission and ATV manufacturer recommendations for age restrictions, ATVs continue to be popular recreational devices for children.