Objective Research on road traffic injuries in China is growing, but little has focused on children. This study describes road traffic injuries among school-aged children in Guangzhou, China and examines the effect of road safety knowledge and risk behaviours on road traffic injuries.

Methods A stratified cluster sample of 3747 students from six primary schools and six middle schools were surveyed. Data were collected on sociodemographics and road traffic injuries during the past year. Logistic regression was used to assess the effects of road traffic risk behaviour and road safety knowledge on road traffic injuries.

Results A total of 403 (10.8%) students reported having at least one road traffic injury during the past year. Children who were boys, in primary school, and from the suburbs were associated with a high proportion of injuries. Bicycle related injuries were the most common (46.0% of all injuries), and motor vehicle related injuries had worst outcomes. Children with low and medium scores of road safety knowledge had 1.5–3 times the odds of injury compared to those with high scores. Students with high scores on the risky road behaviour index had twice the odds of injury (OR 2.04, 95% CI 1.47 to 2.84) compared to students with low scores.

Conclusion Better road safety knowledge and safer walking or cycling behaviours are protective factors for road traffic injuries among Chinese school children. More injury prevention programs are needed to improve road safety knowledge and reduce risk behaviours.