We wanted to study epidemiology and the outcome of severe childhood trauma. A retrospective study was carried out of 347 severely injured children under 16 years of age, who required intensive care or died during a 10-year period in southern Finland. Of the severely injured children, 65.4 per cent were male. Blunt injuries were the most common (83.0 per cent) followed by penetrating injuries (4.9 per cent), burns (4.6 per cent) and others (7.5 per cent). Of the patients with blunt or penetrating trauma, 85.6 per cent had head injury alone, or combined with other injuries. The majority of all injuries (58.2 per cent) and deaths (59.3 per cent) in children were caused by road traffic accidents. Of this patient population, 64 died at the scene, 54 died in hospital and 229 survived. Most of the deceased trauma patients (77.1 per cent) died within the first 6 h following the incident and all the deaths occurred within 9 days. The annual incidence of severe trauma was 14.1 per 100,000 children, and the annual mortality was 4.8 per 100,000. All the trauma deaths occurred immediately or within a few days of the accident. Late trauma deaths due to sepsis or multiple organ failure were not seen in children.