OBJECTIVE: To analyse changes in the incidence of injuries requiring hospitalisation for child passengers in motor vehicle crashes. DESIGN, SETTING AND PARTICIPANTS: Population-based study of children (aged 0 -15 years) residing in New South Wales and admitted to hospital for injuries resulting from a traffic crash in the period 1 July 1998 - 30 June 2005, identified from the NSW Inpatient Statistics Collection. MAIN OUTCOME MEASURES: Age-standardised rates of hospitalisation for injuries, and trends by inpatient demographics, severity of injuries, and injury sites and types. RESULTS: 2297 children were hospitalised for injuries sustained in a motor vehicle crash over the study period. The overall hospitalisation rate for injuries was relatively constant, with a non-significant decline of - 0.4% (95% CI, - 3.1% to 2.3%). The rate of hospitalisation for serious injuries also declined non-significantly (- 5.5% [95% CI, -11.8% to 1.1%]). Only hospitalisation rates for traumatic brain injuries declined significantly (-11.1% [95% CI, -19.0% to - 2.8%]) over the study period. CONCLUSION: The rate of hospitalisation for injuries to NSW-resident child motor vehicle passengers due to traffic crashes has not significantly decreased. High hospitalisation rates and the subsequent burden to the community and public health system make further injury prevention efforts for child motor vehicle passengers a priority.