Background In 2012 in the United States, 13,454 children and adolescents died due to injury and another 9 million visited the emergency department or were hospitalised. However, incidence tells only part of the story. Costs are a better measure of burden by accounting for multiple injury consequences – death, severity, disability – in a single unit of measurement.

Methods We apply an established injury cost model to the Healthcare Cost and Utilisation Program (HCUP) sample-based emergency department and inpatient datasets and the U.S. Multiple Cause of Death file. In addition to medical and work loss costs, we take a societal perspective by including the estimated cost of quality of life and pain and suffering.

Results Injuries (fatal, hospitalised and ED-treated) to 0 through 19 year-olds in 2012 resulted in an estimated $92 billion in medical and work loss costs and an additional $502 billion in quality of life losses. Nonfatal injuries account for the majority (83%) of these costs. Adolescents (ages 15–19) account for 29% of the injuries but 37% of the costs. Falls and struck by/against injuries contribute to 51% of nonfatal injury costs and are the leading causes in all age groups. Assault-related injuries rank 5^th, 9^th, and 4^th among 0–4, 10–14, and 15–19 year-olds, respectively. Self-harm ranks 9^th among 15–19 year-olds. Government costs are high with Medicaid paying for 43% of medical costs. Proportion paid by Medicaid is higher among 0–4 year-olds (54%) and among assault (60%), and unintentional firearm (62%), bite and sting (56%), and hot object/substance (55%) injuries. The most severe and debilitating injuries will result in higher costs. Among nonfatal injuries, near-drownings are the most costly. Traffic-related injuries are also among the most severe with pedestrian, motorcycle, and pedalcyclist injuries ranked #2, #4, and #5 in mean injury cost.

Conclusions Cost data support priority-setting and intervention selection. Effectively addressing falls, struck by/against injuries, and assaults will reduce the burden of injury in the United States.