A controlled population-based study of a childhood injury prevention program in four suburban Massachusetts communities was able to demonstrate a 15.3 percent decrease in injury rates for children ages 0-5 years. A substantial improvement was seen in the relative risk for injury in the intervention as compared with control communities. The major intervention was a pediatric counseling program taking place within a context of various community education efforts. Process data on patient satisfaction and physician compliance, and educational and behavioral outcomes from previously reported studies, when combined with injury incidence data in this report, support the hypothesis that physician counseling may be an important factor in the favorable results observed in these suburban communities. These data also suggest that a decrease in injury incidence may be possible when interactive physician counseling takes place within the context of community education programs. A comprehensive strategy that includes technological, legislative, and educational activities is suggested as the optimal approach to childhood injury prevention.