The rise in child injuries involving all-terrain vehicles in Israel: a call to action.

BACKGROUND: The first five months of 2025 marked a sharp and troubling increase in child injuries involving All-Terrain Vehicles (ATVs) in Israel. During this short period, 17 children were reported as injured or killed in ATV-related incidents - three fatally - with a mean age of 12.5 years (median: 14). This represents a 263% rise compared to previous annual rates, highlighting serious concerns regarding the effectiveness of existing legislation, enforcement and public awareness. The purpose of this study is to analyze long-term trends in ATV-related child injuries and assess the urgent need for regulatory and preventive interventions. METHODS: We conducted a retrospective analysis of unintentional childhood injuries involving ATVs using Beterem Safe Kids Israel's media-based pediatric injury database, from 2008 until May 2025. Trends over time were analyzed using best-fit regression models, and group differences were tested using chi-square tests of independence. RESULTS: Between 2008 and May 2025, 378 ATV-related injuries among children and adolescents were documented, including 41 fatalities. A clear upward trend was observed, with the annual average rising from 21.9 cases per year (2008-2019) to 43 cases per year (2020-2025), and with 22 cases already reported in 2025. Severe and fatal cases more than doubled during this period. Arab children were overrepresented relative to their population share. Incidents peaked during weekends and holidays. A significant quadratic increase in mortality rates over time was identified (R² = 0.751, P < 0.001). ATV-related injuries were disproportionately concentrated among children from lower socioeconomic backgrounds, with 95% of Arab victims and 74% of Jewish victims residing in low- or mid-ranking municipalities. CONCLUSIONS: ATVs present an escalating and preventable danger to child safety in Israel, with recent data signaling a critical and worsening trend. Immediate and decisive action is imperative. Policymakers must urgently implement a uniform minimum age for ATV operation, mandate safety technologies (e.g., Operator Protective Devices), require physical capability assessments, and launch targeted public awareness and enforcement campaigns-especially in rural and underserved communities. These measures are essential to safeguarding children and reversing the alarming trajectory of ATV-related harm.