This article is based on the Hugh Greenwood Lecture delivered at the 2026 Congress of the British Association of Paediatric Surgeons. Childhood injury remains one of the leading causes of death and disability worldwide, disproportionately affecting children in low- and middle-income countries despite the availability of effective prevention strategies. This paper argues that paediatric surgeons have an important role that extends beyond the operating theatre and presents a practical roadmap for reducing childhood injury based on the public health approach to injury prevention. Seven interdependent pillars are proposed: surveillance, risk factor identification, intervention development, implementation, trauma system strengthening, evaluation and advocacy. Together, these provide a framework for translating evidence into sustained reductions in childhood injury through contextually appropriate prevention, stronger trauma systems and leadership from the paediatric surgical community. EVIDENCE LEVEL: Level V.