Purpose Over 8,000 American adolescents ages 14-15 years require medical attention owing to pedestrian injury annually. Cognitive factors contributing to pedestrian safety include reaction time, impulsivity, risk taking, attention, and decision making. These characteristics are also influenced by sleep restriction. Experts recommend that adolescents obtain 8.5 hours of uninterrupted sleep each night, but most American adolescents do not. Inadequate sleep may place adolescents at risk for pedestrian injury. Methods Using a within-subjects design, 55 14- and 15-year-olds engaged in a virtual reality pedestrian environment under two conditions, scheduled a week apart: sleep-restricted (4 hours' sleep the previous night) and adequate sleep (8.5 hours). Sleep was assessed using actigraphy and pedestrian behavior via four outcome measures: time to initiate crossing, time before contact with vehicle while crossing, virtual hits or close calls and attention to traffic (looks left and right). Results While acutely sleep restricted, adolescents took more time to initiate pedestrian crossings, crossed with less time before contact with vehicles, experienced more virtual hits or close calls, and looked left and right more often compared with when adequately rested. Results were maintained after controlling for age, gender, ethnicity, and average total sleep duration before each condition. Conclusions Adolescent pedestrian behavior in the simulated virtual environment was markedly different, and generally more risky, when acutely sleep restricted compared with adequately rested. Inadequate sleep may influence cognitive functioning to the extent that pedestrian safety is jeopardized among adolescents capable of crossing streets safely when rested. Policy decisions might be educated by these results. © 2013 Society for Adolescent Health and Medicine. All rights reserved.