【Objective】 To investigate the main causes of accidental death of children under 5 years old and their epidemiological distribution in Guangdong Province from 2018 to 2022, it provides theoretical basis for formulating further preventive measures and intervention methods. 【Methods】 Children under 5 years of age who died in Guangdong Province from 2018 to 2022 were selected as the study subjects. The International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes S00-T98 and V01-Y98 were used to classify cases of accidental death, and the related rate and composition ratio were calculated to analyze the causes of accidental death in children and their distribution. 【Results】 From 2018 to 2022, the total mortality rate in Guangdong Province was 2.94‰, with a total of 21 329 deaths. Among these deaths, 3 819 were accidental deaths (0.53‰), the sex ratio of males to females was 1.29∶1, and the sex distribution of accidental death among all age groups showed significant difference (χ²=16.38, P<0.01). The top 3 causes for accidental deaths were accidental suffocation (1 590/3 819), drowning (926/3 819) and traffic accident (527/3 819). The accidental death rate of boys at all ages was higher than that of girls, although the difference was not statistically significant (χ²=13.68, P=0.19). The cause of death varied significantly among different age groups (χ²=1 723.28, P<0.01), and the treatment before death was statistically significant (χ²=174.31, P<0.01). 【Conclusion】 Accidental suffocation and drowning are the main causes of death in children under 5 years old in Guangdong Province. Age-specific preventive measures should be implemented to enhance the identification and prevention of accidental injuries among children and their parents, thus reducing the accidental death rate in this age group.