Background The relative significance of child injury as a cause of preventable death has increased as the ability to control infectious diseases has improved. Unintentional child injuries are now a major global cause of death and disability with the greatest burden falling on those who are most disadvantaged.

Aim/Objectives/Purpose A systematic review of long term trends in child injury mortality was conducted to review progress and consider the implications for policy, practice and research.

Methods We systematically collated and quality appraised data from publications and documents reporting unintentional child injury mortality, over periods of 20 years or more. A critical narrative synthesis explored trends by injury type and by country income group, and reported disparities in injury occurrence by age, sex, ethnicity and socio-economic group.

Results/Outcome Thirty one studies meeting the inclusion criteria were identified of which 30 were included in the narrative synthesis. Only six were from middle income countries and none were from low income countries. An overall trend in falling child injury mortality masked rising road traffic injury deaths, evidence of increasing vulnerability of adolescents and widening disparities within countries when analysed by ethnic group and socioeconomic status.

Significance/Contribution to the Field We need to adapt our knowledge of effective interventions to reduce child injury mortality for low income countries, particularly where rapid economic and social change may be increasing exposure to injury risks. Within countries, advocacy and interventions to reduce disparities in injury mortality by age, ethnicity and socioeconomic status should be prioritised.