Purpose All-terrain vehicle (ATV)–related injuries continued to increase in recent years. We aimed to analyze the ATV injury patterns at our institution to help structure public awareness campaign and encourage governmental regulation, with the ultimate goal of injury prevention. Methods A retrospective review of all ATV-related admissions at a pediatric trauma center was performed. Results From 2001 to 2004, 50 ATV-related injuries requiring hospital admission were identified. The annual incidence had increased 2.5-fold from 2001 (8 admissions) to 2004 (20 admissions). The ages ranged from 3 to 17 years (median, 13 years), with equal sex distribution. Fifty-four percent of admissions were traumatic brain injuries, 28% had orthopedic injuries, 14% with facial fractures, and 4% with abdominal injuries. Average length of stay was 6 days (range, 1-47 days); 5 of the 7 intensive care unit admissions occurred in 2004. Eighty-four percent of patients did not wear helmet (97% among those from northern communities). Conclusions Both the incidence and severity of ATV-related injuries are increasing in a regional pediatric trauma center. There is a lack of regulation enforcement and public awareness of the danger of ATV use in children. Efforts to ensure helmet use and limit operator age are urgently needed to reduce childhood ATV-related injuries.