The aim of the study was to describe patterns and trends in intentional injury death rates in children and teenagers. Analyses were carried out on data from the Office of National Statistics on all intentional injury deaths in people aged 0 to 19 years, in England and Wales, from 1980 to 1995. Trends in death rates were examined using Poisson regression modelling, and class-specific death rates were estimated using the Registrar General's Standard Classification of Occupations. Between 1980 and 1995, there has been a substantial fall in the unintentional injury death rate, but no reduction in the intentional injury death rate. Intentional injuries made up 13 per cent of injury and poisoning deaths in 1980, and 25 per cent of such deaths in 1995. Each year in England and Wales an average of 335 children and teenagers die as a result of homicide, suicide and injuries of undetermined intent. Older teenagers (15-19 years) account for 70 per cent of intentional injury deaths, children 0-4 years account for 18 per cent, and children 5-15 years account for 12 per cent. Of the 5361 intentional injury deaths, 45 per cent were classified as injury undetermined whether accidentally or purposely inflicted, 35 per cent were classified as suicide, and 20 per cent were classified as homicide. With the exception of suicide, there are steep social class gradients for each category of intentional injury. The homicide rate for children in social class V is 17 times that for children in social class I. For all intentional injury, homicide, suicide and injuries of undetermined intent, the relative risk of death for manual vs. non-manual was higher for the four year period 1992-1995 than in the four year period 1980-1983. Intentional injury is responsible for an average of 335 deaths of children and teenagers each year in England and Wales. Unlike for unintentional injury, there has been no reduction in death rates from intentional injury, which now accounts for 25 per cent of all injury deaths. There is a steep social class gradient in intentional injury death rates, which has widened over the period 1980-1995.