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Background Paediatric injuries are the leading cause of morbidity and mortality worldwide, with unintentional trauma disproportionately affecting vulnerable populations. Social determinants of health, including socioeconomic status, race and insurance type, significantly influence injury outcomes. Injury pyramids serve as a valuable tool for visualising these disparities and informing targeted prevention strategies.Methods A retrospective cohort analysis was conducted on 6466 paediatric trauma cases recorded at St. Joseph’s Children’s Hospital (2010–2021) in Tampa, Florida. Incidence rates per 100 000 persons were calculated for emergency department visits, hospitalisations and deaths, stratified by sex, age, race, county and insurance type. χ² analysis assessed statistical significance.Results The injury pyramid revealed 88.6 emergency visits, 47.6 hospitalisations and 2.4 deaths per 100 000 persons. Falls, motor vehicle crashes and sports-related injuries were the leading causes of emergency visits and hospitalisations. Drowning, motor vehicle crashes and gunshot wounds were the primary causes of death. Black children had a higher incidence of firearm-related fatalities, while White children had higher rates of drowning and motor vehicle fatalities. Publicly insured children exhibited greater injury severity compared with those with private insurance.Conclusions Injury pyramids effectively highlight paediatric trauma disparities, emphasising the need for population-specific prevention strategies. Injury pyramids are effective in intervention development, mitigating health disparities and informing policy development. The integration of conceptual frameworks such as the Haddon Matrix and Injury Equity Framework may enhance understanding of the social and structural contributors to paediatric trauma disparities.