OBJECTIVE: To provide a descriptive demographic and environmental account of pedestrian injuries among children aged < or =15 years in Jefferson County, Alabama. METHODS: This was a retrospective study with a case definition for inclusion of individuals, aged < or =15 years, who suffered a pedestrian injury and sought care at The Children's Hospital of Alabama between 1989 and 1991. Demographic and injury-related information was obtained from the medical record and analyses were performed using t-test and a simple correlation. RESULTS: The majority of the cases were nonwhite, and nearly half had Medicaid or were uninsured. The most common injuries were fractures and closed head trauma. The geographic locations of injury events were not uniformly distributed: a comparison of areas wherein an injury occurred with those that were injury-free revealed a number of significant differences with regard to specific demographic, socioeconomic, and ecological factors. CONCLUSIONS: Some of the possible manageable environmental risk factors identified in this study were relatively high posted speed limits; sidewalks that were narrow, absent, or in a state of disrepair; vehicular parking on both sides of the street; and the absence of a divided highway. In this community, the most cost-effective educational intervention may best be targeted to elementary-aged schoolchildren living in areas with low-income families and that have a high density of children.