Objective: To review and compare the epidemiology and treatment of mandibular fractures in subgroups of a pediatric population. Methods: We conducted a retrospective review of pediatric patients (age, <= 18 years) with mandibular fractures treated at our institution from January 1996 through November 2011. Results: We identified 122 patients (93 [76%] male) with 216 mandibular fractures. The prevalent mechanisms of injury were motor vehicle accidents (n = 52 [43%]), sports injuries (n = 24 [20%]), and assault (n = 13 [11%]). The most common fracture sites were subcondylar, parasymphyseal, angle, and body. Two patients (2%) were treated conservatively by observation only, 67 (55%) underwent maxillomandibular fixation alone, 41(34%) underwent maxillomandibular fixation with plate fixation, and 7 (5.7%) underwent plate fixation only. The average duration of maxillomandibular fixation was 26 days (range, 7-49 days). Complications occurred in 11 patients (9.0%) over a mean follow-up of 92 days (range, 21-702 days). Fifty patients (41.0%) had comorbid conditions or a history of mental illness at the time of injury, including attention deficit hyperactivity disorder (n = 11 [9%]), mental disorders other than attention deficit hyperactivity disorder (n = 23 [19%]), and asthma (n = 17 [14%]). Twenty-six patients (21%) had a history of substance use, the most common being tobacco (n = 18 [15%]), alcohol (n = 13 [11%]), and marijuana (n = 11 [9%]). Conclusions: Treatment approach and outcomes were affected by age and fracture characteristics. In addition, a marked proportion of this cohort had preexisting mental disorders and history of substance use, which may have implications on treatment approach. (C) 2014 Elsevier Ireland Ltd. All rights reserved.