Background: Comparatively little is known about the cognitive appraisals and coping styles of child road traffic accident (RTA) survivors that are associated with chronic post-traumatic reactions. Methods: Seventy-five children and young people aged 7-18 who were involved in a road traffic accident and attended an accident and emergency department were assessed 8 months after their accident. Post-traumatic symptoms were assessed by diagnostic interview (CAPS-C) and self-report questionnaires (IES). Demographic, accident and injury severity variables were recorded. Informed by the Ehlers and Clark (2000) model, trauma memory, subjective appraisals of the trauma and cognitive coping styles were assessed. Results: Gender was the only non-cognitive variable associated with significant post-traumatic reactions and explained 5-6% of the overall variance. Trauma memory did not significantly contribute to the final regression model. The addition of the remaining cognitive factors assessing subjective appraisals of the trauma and cognitive coping style resulted in the model accounting for 61-65% of the variance of post-traumatic stress disorder (PTSD) symptoms 8 months post trauma. Conclusion: This study adds support to the applicability of the Ehlers and Clark (2000) cognitive model to children. The results indicate that the theoretically determined appraisals and cognitive coping styles are associated with chronic post-traumatic reactions. The findings suggest the need to develop trauma-focused interventions for children that directly address these key cognitions during therapy.