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OBJECTIVE. To investigate rural-urban differences in severity of injuries, by means of age, sex and duration of hospitalization of injured children in northeastern Poland. METHODS. The study included children admitted to the Department of Pediatric Orthopaedics and Traumatology in between 2002-2005 (1322 patients) and 2012-2013 (1725 patients) due to injury. We applied the rural-urban division on the base of number of inhabitants (rural – below, urban – over 25000). We divided injuries into four categories based on severity. Statistical analysis was performed to compare the risk of hospitalization due to different types of injuries among children in different age and sex groups, living in rural and urban areas RESULTS. Children from urban areas have a higher risk of hospitalization compared to their peers living in rural areas due to two least severe categories of injuries. Children from rural areas had much higher risk of hospitalization due to most severe injuries. Results were consistent for both time intervals.. The average duration of hospitalization was significantly longer among rural populations. However, in both rural and urban areas the mean length of stay has been shortened in comparison with the years 2002-2005. The average age of urban patients has been reduced over the years and remained stable among rural population. In both groups boys comprised the majority of patients with all kinds of injuries. CONCLUSIONS. Analysis of the risk of hospitalization among children from rural and urban areas brings constructive conclusions only after applying the division based on severity of injuries. Children living in rural areas and small towns are at a higher risk of suffering severe injuries that pose a risk of permanent disability, and of longer hospitalization because of them, compared to children living in larger cities.