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OBJECTIVES: Injuries are the leading cause of death and disability for U.S. children, but little research exists on injury in the home environment. The purpose of this study was to estimate the rate and severity of and trends in unintentional residential injury for U.S. children <20 years for 1993-1999. METHODS: Data on emergency department (ED) visits were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS). Rates and 95% confidence intervals (CIs) were calculated using SUDAAN. Chi-square analysis was used to test for differences among proportions. Time trends were analyzed using linear regression. RESULTS: Residential injuries accounted for an average of 4.01 million (95% CI 3.50 million, 4.56 million) ED visits each year for U.S. children, representing 39% of unintentional injury ED visits. There were an average of 531,000 (95% CI 456,000, 606,000) visits with moderate-to-severe injuries, resulting in 73,680 (95% CI 59,715, 87,645) hospital admissions annually. The rate of residential injury visits (excluding unknown locations) was 5.6 per 100 (95% CI 4.9 per 100, 6.4 per 100). The visit rates for children <5 years of age were higher than those for children >9 years (p<0.0001). Males had a higher rate of visits than females (p=0.01). Falls were the leading mechanisms, resulting in 1.5 million ED visits per year (95% CI 1.3 million, 1.8 million). Residential injury rates decreased by 28% over time (p<0.02), from 6.3 per 100 (95% CI 3.4, 9.2) in 1993 to 4.5 per 100 (95% CI 2.3, 6.7) in 1999. CONCLUSIONS: The predominant location of injury for U.S. children is the home, accounting for 4.01 million ED visits and more than 70,000 hospitalizations each year. Efforts targeted to the home environment are needed to reduce morbidity and mortality from unintentional injury in U.S. children.