Only 45% of riders reported always wearing a helmet, and 25% reported never wearing a helmet. All terrain vehicles ATVs are motorised, gasoline powered vehicles, weighing up to 1000 pounds, with large, low pressure tyres, a seat to be straddled by the user and handlebars for steering. These vehicles are designed for use by riders on off road, non paved surfaces. ATVs were first introduced in the 1970s, and by 2010, an estimated 10. 6 million 4 wheel ATVs were in use in the USA. 1 As ATVs gained in popularity, particular concern arose about ATV related injuries among children. Because young riders often lack the physical strength, cognitive abilities and fine motor skills to operate ATVs properly, their risk for injury is greater. 2ATV related fatalities and non fatal injuries to children and youth in the USA have been well documented. 1 ,3 ,4 Since 1985, the US Consumer Product Safety Commission CPSC has published annual national estimates of ATV related fatalities and emergency department visits for ATV related non fatal injuries among children and adults. 1 Much less is known, however, about ATV riding among US children and youth. To our knowledge, the most recent publicly available national estimates of ATV riding among youth are more than a decade old.