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Despite improvements in occupant safety, traffic fatalities are the leading cause of death for 5–14 year olds in high income countries; representing 19% of all fatalities. Child pedestrian motor vehicle collisions (PMVC) are a particular issue, as although the majority of child fatalities occur in vehicles, pedestrian fatality rates are increasing in some locations. Children are especially vulnerable due to their small stature and developmental abilities to negotiate road traffic and high vehicular speed. These major risk factors are not equally distributed across society; children in lower income and racialized communities are at increased risk of injuries and death as pedestrians. Vehicle speed is the key variable in terms of determining injury severity-slowing down traffic is the most important variable that can be changed to reduce injuries and fatalities. Because of growing parent perceptions of traffic danger, active transportation in children has decreased over time, which has effects on children’s physical activity and health, as well as traffic congestion near schools. This chapter summarize these issues and restates the importance of modifying the roadway built environment, creating appropriate regulatory changes and enforcing compliance to establish safer roadways and encourage active transportation for our children.