The government's record on preventing accidental injuries to children is a "disgrace", watchdogs have said.
Accidents are a leading cause of illness and death in children
Two million children a year visit A&E because they have been hurt in an accident, the Audit Commission said.
And not enough has been done to tackle the problem, which is thought to cost the NHS £149m a year.
The report, produced with the Healthcare Commission, found "shocking" inequalities in rates of accidents in children from poor families.
Injuries such as those caused by burns, falling down the stairs and poisoning are a leading cause of death and illness in those aged one to 14 years old.
In recent years the number of deaths from accidents in children has fallen, according to the joint report.
However, inequalities between the poorest and more affluent families are widening.
Children of parents who have never worked or have been unemployed for a long time had 13 times the risk of dying from an accident and were 37 times more likely to die as a result of exposure to smoke, fire or flames than children of parents who worked in managerial or professional jobs.
In 1999 the government set a target to reduce the death rates from accidents (in all age groups) by at least one fifth and to reduce the rate of serious injury from accidents by at least one tenth by 2010.
At the time, unintentional injury was highlighted as the greatest single threat to the lives of children.
But poor collection of data has made it hard to measure progress.
The report criticised lack of coherent strategy from government and failure to tackle the problem at a local level.
Ad-hoc initiatives with poor co-ordination have not had enough of an impact, they said.
Professor Sir Ian Kennedy, Healthcare Commission chair, said government and local authority efforts to reduce rates of accidents in children were "a disgrace".
"For too long, this issue has been pushed down the agenda. No single agency or body has taken a clear lead.
"The right of all children to be protected from avoidable accidents and injuries must be embedded in the work of those who provide public services.
"Health services need to collect robust data on the types and causes of injuries that they see in the children who they treat."
Michael O'Higgins, chair of the Audit Commission, added: "Few of us can imagine the heartache caused by the loss of a child, but the most recent figures showed that 230 children died in one year from accidents that might have been prevented.
"The inequalities between different socio-economic groups are also shocking. To tackle this, local bodies must apply concerted and rigorous action."
The report did highlight example of good practice around the country including a scheme in Burnley, Pendle and Rossendale to make homes safer for young children.
Janice Cave, director of public affairs at the Royal Society for the Prevention of Accidents, said the report was a "much needed breath of fresh air".
"We need the government to take the lead in ensuring everything possible is being done throughout the country to pool information and reduce suffering."
A Department of Health spokespersoon said: "Every mother currently receives a copy of 'Birth to Five', a Department of Health produced guide which contains advice on protecting and teaching children about safety.
"We realise the importance of accident prevention and we will look at the report's conclusions with great interest."