Background Head injuries represent the most common and most serious injury occurring in childhood. We analysed the profile of childhood head injury patients treated in a Paediatric Trauma Unit over a 25 years period.

Methods A retrospective record-based study was performed at the Trauma Unit of the Red Cross War Memorial Children’s Hospital in Cape Town, South Africa. The Childsafe South Africa Childhood Injury Surveillance System was data-mined for the information. Inclusion criteria were children under the age of 13 years and presenting with a head injury during the period between January 1991 and July 2025.

Results 10205 children presented after a sustaining a head injury. There were 6457 boys and 3745 girls. In 281 (2.75%) of cases the children were injured as a result of physical violence. The majority of children presented with superficial lacerations and abrasions, mostly affecting the scalp and skull. Injuries were mainly caused by falls from a variety of heights or were traffic-related. Almost two-thirds of traffic-related injuries involved children as victims of a motor vehicle crash. The majority of head injuries in young children occurred in the vicinity or within the child’s own home. In 56 cases the severity of the injury was not recorded. From the remaining 10146, 6864 (67.3%) were classified as minor; 2918 (28.6%) as moderate; 225 (2.2%) as severe and 135 (1.3%) children died within 24 hours after admission.

Conclusions Head injuries are a significant and ongoing cause of morbidity in particular of young children and represent the most important component of childhood injuries. Protection of young children, especially in their own home and on the streets requires urgent attention.