Objective To describe the epidemiology of pedestrian road traffic injury in Lima and to identify associated child-level, family-level, and school travel-related variables.

Design Case–control study.

Setting The Instituto Nacional de Salud del Niño, the largest paediatric hospital in the city.

Participants Cases were children who presented because of pedestrian road traffic injury. Controls presented with other diagnoses and were matched on age, sex and severity of injury.

Results Low socioeconomic status, low paternal education, traffic exposure during the trip to school, lack of supervision during outside play, and duration of outside play were all statistically significantly associated with case–control status. In multivariate logistic regression, a model combining the lack of supervision during outside play and the number of the streets crossed walking to school best predicted case–control status (p<0.001).

Conclusions These results emphasise that an assessment of children's play behaviours and school locations should be considered and integrated into any plan for an intervention designed to reduce pedestrian road traffic injury. A child-centred approach will ensure that children derive maximum benefit from sorely needed public health interventions.