This research used data from the Victorian State Trauma Registry from 2006 to 2016 to investigate causes, characteristics and temporal trends of paediatric major trauma. Of the 1511 paediatric major trauma patients, most were male (68%), had sustained blunt trauma (87%) and had injuries resulting from unintentional events (91%). Motor vehicle collisions (15%), struck by/collisions with an object or person (14%) and low falls (13%) were the leading mechanisms of injury. Compared with those aged 1–15 years, a greater proportion of non-accidental injury events were observed in infants (<1 year) (32%). This study demonstrated no change in the incidence of paediatric major trauma over an 11-year period. Given the potential lifelong impacts of serious injury in children, additional investment and coordination of injury prevention activities are required.