All-terrain vehicles (ATVs) continue to be an increasing cause of injuries and deaths in children, especially in rural communities. More children die in the United States each year from ATV-related events than from bicycle crashes. The purpose of this study was to determine the ATV anticipatory guidance practices of primary care providers, as well as their attitudes, knowledge, and the barriers faced in educating families about the risk of ATV use. An electronic survey was administered to primary care providers belonging to state medical societies. More than 60% of respondents (Total N = 218) believed that ATV anticipatory guidance was important to provide to pediatric patients and their families. However, 78% stated they provide ATV safety counseling less than 10% of the time during regular pediatric exams, and only 12% stated they do so greater than 25% of the time. Families rarely ask providers for advice on ATV safety issues; 84% of providers were asked once a year or less. ATV knowledge scores were low (median score 2 of 12); however, those with previous ATV exposure had significantly higher scores. Many respondents affirmed insufficient knowledge (47%) and inadequate resources (63%), but the most commonly identified barrier was that it was not a routine part of their practice. Providers in the study demonstrated limited knowledge, reported multiple barriers, and provided little or no ATV safety counseling. However, they consider ATV anticipatory guidance important for their patients. Armed with increased knowledge and appropriate resources, providers could play a significant role in promoting ATV safety.