There is increasing concern over the unregulated use of recreational off-road motor vehicles. A review of 207 patients admitted to a tertiary care hospital over a 5-year period, as well as deaths due to use of recreational vehicles, elicited the following information. Recreational accidents predominantly involved men in their mid-twenties. Children younger than 16 years were more frequently involved in all-terrain vehicle (ATV) or dirt-bike accidents and constituted more than one-third of the total. There was a ninefold increase in ATV accidents over the study period, so that by 1985 ATVs were the primary cause of off-road injuries (52%). The musculoskeletal system was most frequently injured (66%) followed by the head and face (25%). There was permanent disability in 10.6%, and 33% of the recreational deaths were in children younger than 16 years. The inherent instability of ATVs was confirmed by the finding that in 60% of accidents the vehicle had rolled or flipped. Stricter licensing requirements should be implemented, and public education is required to draw attention to the danger of these vehicles, particularly to children. There is a need for proper safety equipment and driver training. The issue of vehicle design must also be addressed by the industries concerned.