Background Injuries in childhood are largely preventable but continue to be a public health problem. However, the factors that contribute to injury occurrence have not been quantified at the population scale using primary care data.

Aims/Objectives/Purpose We used The Health Improvement Network database from the UK to identify risk factors for thermal injury, fractures and poisoning in pre-school children in order to inform the optimal delivery of preventative strategies.

Methods We used a matched, nested case-control study design. Cases were children under 5 with a first medically-recorded injury, comprising 3649 thermal injury, 4050 fracture and 2193 poisoning cases, matched on general practice to 94 620 control children.

Results/Outcome Younger maternal age and higher birth order increased the odds of all injuries. Children's age of highest injury risk varied by injury type; compared with children under 1, thermal injuries were highest in those age 1–2 (OR=2.43, 95% CI 2.23 to 2.65), poisonings in those age 2–3 (OR=7.32, 95% CI 6.26 to 8.58) and fractures in those age 3–5 (OR=3.80, 95% CI 3.42 to 4.23).

Increasing deprivation was an important risk factor for poisonings and thermal injuries as was alcohol misuse by a household adult (OR=1.73, 95% CI 1.26 to 2.38 and OR=1.39, 95% CI 1.07 to 1.81 respectively) and maternal diagnosis of depression (OR=1.45, 95% CI 1.24 to 1.70 and OR=1.16, 95% CI 1.02 to 1.32 respectively).

Significance/Contribution to the Field Maternal depression, adult alcohol misuse and deprivation represent important modifiable risk factors for thermal injury and poisoning but not fractures in preschool children. Since these risk factors can be ascertained using routine primary care records, at risk children can be identified and offered preventative interventions.