We reanalyzed data from the Pedestrian Injury Causation Study (PICS) for 1035 urban pedestrian injuries to children and youth less than 20 years of age. Analysis of variance with the Injury Severity Score (ISS) as the dependent variable was used to evaluate variables describing the characteristics of the pedestrian, the vehicle, the driver, and the circumstances under which the collision occurred. The mean injury severity score was 5.6. Nearly 80% of pedestrians had a minor injury, 13% moderate, and 7% severe; 4.5% of these pedestrian were killed. Multivariate analysis revealed that vehicle travel speed greater than 30 mph, pedestrian age less than 5 years, time of day either early morning or late afternoon, residential zone, type of road including collectors and major roads, and center travel lanes were associated with greater severity of injury. Attempts by the driver to avoid the collision by braking or other avoidance maneuvers were associated with reduced injury severity. Even on local streets and in residential zones, nearly 20% of children were struck by vehicles exceeding 30 mph, and these children were injured much more severely than children struck by more slowly moving vehicles.