OBJECTIVE: To describe the profile of injuries sustained by children in school accidents and suggest preventive measures. DESIGN: A five month prospective study of children attending an urban accident and emergency (A&E) department. SUBJECTS: 500 children who sustained injuries in school due to a variety of activities. RESULTS: 10 and 12 year old pupils suffered most injuries in school grounds/playgrounds, on concrete, or on grass/soil surfaces due to random activities resulting in striking or being struck by objects/persons, tripping or slipping, and sports (mainly football); 65.5% of these activities were not supervised and 67.4% occurred "out of lessons"; 22% sustained fractures or dislocations, 28.2% needed follow up treatment, and 1.4% were admitted. CONCLUSIONS: Injuries to children in school are a cause for concern. Effective preventive measures should concentrate on (a) specific target areas using schemes based on individual school, and (b) establishing a credible system of monitoring of their effectiveness.