Objective To establish the incidence of road transport collision (RTC) fatalities in the Irish paediatric population, examining trends in fatality rates over a period of 25 years, during which several national road safety interventions were implemented.

Study design Retrospective review of death registration details of children 0–19 years in Ireland between January 1991 and December 2015. Trends in mortality rates were investigated using average annual per cent change and Poisson regression analysis.

Results Proportionate RTC mortality, the majority of which occurred on public roads (94.1%, n=1432) increased with age; <0.3% (<1 year), 8.3% (1–14 years) and 18.4% (15–19 years) (2011–2015 average). Over time, rates declined significantly in all age groups; reductions of 79.0% (4.0 to 0.84/100 000, 1–14 years) and 68.4% (15.5 to 4.9/100 000, 15–19 years) resulted in 537 (95% CI 515 to 566) fewer child deaths (1–19 years) over the period 1996–2015. This reduction was evident for both road user types, the greatest decline (84.8%) among pedestrians 1–14 years (2.1 to 0.32/100 000) and the lowest (66.5%) among occupants 15–19 years, the majority of whom were male (12.4 to 4.2/100 000). The rate of decline was greatest during periods coinciding with introduction of targeted interventions. Risk of death in children 1–14 years was halved in the period after 2002 (incidence rate ratio (IRR) 0.52) while in children 15–19 years old, a significantly lower RTC fatality risk was evident after 2006 and 2010 (IRR 0.68 and IRR 0.50).

Conclusion Child and adolescent mortality from RTCs has declined dramatically in Ireland, in excess of reductions in overall paediatric mortality. However, rates remain higher than in other EU countries and further effort is required to reduce the number of deaths further, particularly among adolescent males.