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The paper reviews one hundred and three (103) cases of restrained children involved in motor vehicle crashes and admitted to the level I trauma center at Children's National Medical Center (CNMC). Thirty percent (30%) of these cases involved injuries with an Abbreviated InjuryScore (AIS) severity of 3 or greater. All cases are classified first by type of restraint system, i.e. infant seat, convertible seat, booster seat, lap belt, and lap and shoulder belt, and second, by type of injury sustained, i.e. head/face and neck, upper extremity, thorax, pelvic and abdominal, and lower extremity. The links between these classifications are examined to identify particular injury patterns associated with the use of individual restraint systems, e.g. the incidence of pelvic and abdominal injury associated with the use of both lap and lap and shoulder belts. For the severe injury cases the paper further examines the injury mechanisms for the most commonly observed patterns.