One identified high-risk group for injury is children of low socio-economic status. One of the enduring controversies in the prevention field is whether programs should be offered universally to the whole population or target specific “high-risk” groups. The debate on universal versus targeted programs has been ongoing. This paper discusses the implications of universally offered and targeted injury prevention programs. An analysis of the targeted versus universal conundrum suggests that a comprehensive constellation of universal and targeted programs are conducive to addressing the various levels of injury risk to children. However, universal models of prevention have advantages in terms of promoting safety through wide-ranging public policies. Considering the social determinants of health can enhance the identification of injury prevention priorities amongst researchers and health and social service professionals. Given the recent economic context of widening income disparities, injury prevention practitioners and child advocates can learn from existing success stories of universal programs in injury prevention as a way to mute the effects of socio-economic inequality. Future directions for research and practice are discussed.