Children 4 to 9 years of age because of their anatomy and size represent a special category with respect to occupant restraint in motor vehicles. These children have outgrown the child safety seats and are placed in seat belts designed for the adult body configuration. This study was undertaken to analyse patterns of injury and severity of injury among restrained 4 to 9 year old children, by seat location and crash impact site. Overall, 85% of the children sustained a minor injury. However, the striking feature of this study was the high proportion of children in all seat locations and impact sites who sustained head/face injury, 64%. Of the serious head/face injuries, 41% were located in outboard seating positions and involved in an on-site lateral impact with vehicle intrusion. There were few cases of serious injuries among those in the back seat in frontal, rear and lateral off site impacts. Some serious injuries occurred among those in the front seat in frontal impacts. Improved occupant protection is needed 1) in lateral on site impacts and 2) to prevent head contact with the vehicle interior among restrained 4-9 year olds.