Background Paediatric trauma following road traffic collisions (RTCs) represents a significant public health burden. This study aims to influence road safety in Wales.

Methods Police (STATS19) and healthcare databases covering all or part of Wales were analysed, compared and mapped from 2017 to 2019 for RTCs involving children aged 0–16 years.

Results STATS19 under-reports RTCs, recording 1859 road traffic injuries (RTIs) for all Wales compared with 1170 RTIs at one tertiary hospital in South East Wales. Boys aged 11–16 years had the highest injury rates (92.2 per 100 000 population). Injuries peaked at school journey times. The rate ratio of injury was 2.0 (95% CI 1.7 to 2.4) for the most deprived compared with the least deprived areas.

Conclusion Improvements in data quality are essential to influence road policy. Improved road safety is needed in all communities but must be further enhanced in the most deprived areas, where the burden of injury is highest.