OBJECTIVES: To identify individual and household characteristics associated with serious falls, poisonings, burns and road traffic injuries (RTIs) for children in Lima, Peru. METHODS: 5061 households consisting of 10,210 children were included in this community based, cross-sectional study in San Juan de Miraflores (SJM), a low income, urban district of Lima, Peru. Households were eligible if there was a consenting adult and at least one resident child aged < or =18 years. A door to door survey was conducted in SJM, collecting childhood injury, demographic, and socioeconomic data. Analysis was done at the individual and household level for injuries severe enough to have required medical consultation. RESULTS: The greatest burden of injury was from falls and RTIs. For individuals, male gender and age were the most important predictors of injuries. Households in which multiple injuries were reported were more likely to be poor (odds ratio (OR) 1.66, 95% CI 1.24 to 2.22) and overcrowded (OR 1.88, 95% CI 1.20 to 2.94). The occurrence of serious falls, poisonings, burns, and pedestrian RTIs significantly increased the likelihood of a second serious injury in the home (adjusted ORs ranged between 1.88 and 2.99). CONCLUSION: All children from households in which an unintentional injury has occurred appear to have an increased likelihood of future injury; such high risk households may be readily identifiable in the clinical setting. Interventions in this environment designed to prevent subsequent injuries merit further investigation.