The study objectives were to estimate the standardized incidence and evaluate factors associated with moderate/severe pediatric traumatic brain injury (p-TBI) in children aged 5–15 years in Western, Mexico. The study was cross-sectional in design. We estimated the standardized incidence of moderate/severe p-TBI using the direct methods of the World Health Organization (WHO) standard populations. We utilized the Glasgow Coma Scale (GCS) to identify moderate/severe p-TBI patients (GCS ≤ 13). Logistic regression analysis was applied to evaluate variables associated with moderate/severe p-TBI. The standardized incidence of patients diagnosed with moderate/severe p-TBI was 31.0/100,000 person-years (95 % CI 28.7–33.4). According to age, the moderate/severe TBI group was included. A total of 254 (38.5 %) patients were aged 5–9 years, 343 (52.0 %) were aged 10–14 years, and 62 (9.5 %) were aged 15 years. Factors associated with moderate/severe TBI in the crude analysis were male sex (OR 5.50, 95 % CI 4.16–7.39, p < 0.001), primary school (OR 2.15, 95 % CI 1.62–2.84, p < 0.001), and falls (OR 1.34, 95 % CI 1.02–1.77, p = 0.035). Factors associated with moderate/severe p-TBI in the adjusted analysis were male sex (OR 6.12, 95 % CI 4.53–8.29, p < 0.001), primary school (OR 3.25, 95 % CI 2.31–4.55, p < 0.001), and falls (OR 1.78, 95 % CI 1.28–2.47, p < 0.001). The incidence of moderate/severe p-TBI in children aged 5–15 years in western Mexico in this study was higher than that in other studies. One of the biggest factors associated with moderate/severe p-TBI was male sex, specifically those with lower education levels and those who were prone to falls. •The standardized incidence of moderate TBI diagnoses patients was 24.5 (95 % CI 22.6–26.4).•The standardized incidence of severe TBI diagnoses patients was 5.1 (95 % CI 3.6–7.3).•Falls were the leading cause of moderate/severe TBI.