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Background/aims Children are at higher risk of injury from all-terrain vehicles (ATVs) than adults. Legislative policy is one approach to addressing this public health issue. This study introduces a novel method for categorising state ATV legislation by strength and evaluates its impact on paediatric trauma.Methods ATV safety laws from all 50 states were analysed and scored using three criteria: age requirements (2 pts: >16-year old independent, >12-year old supervised; 1 pt: >16-year old independent only; 0 pts: less stringent), roadway restrictions (2 pts: no highway use; 1 pt: highway use with exceptions; 0 pts: no restrictions) and safety education (1 pt: required; 0 pts: not required). Composite scores (0–5) were categorised as strong (4–5), moderate (2–3) or weak (0–1). The Fatality Analysis Reporting System was used to calculate an 11-year average (2010–2020) adjusted paediatric ATV injury/fatality rate per state. These rates were correlated with law strength.Results Five states had strong laws, 28 moderate and 17 weak. The median annual-adjusted paediatric ATV injury/fatality rate was 0.84 (IQR 0.45–1.92). States with strong laws had significantly lower rates than those with moderate or weak laws (p=0.035). However, no significant correlation was found between individual composite scores and injury/fatality rates.Conclusions This study provides a framework for scoring paediatric ATV safety laws. States with strong laws have lower paediatric ATV trauma rates. Further analysis is needed to account for factors like population density.