• We reviewed the English language scientific literature about equestrian injuries among children and young adults. All studies showed that more females than males were injured, with falls from horses being the most common cause of injury. Fractures were common, and head injuries were associated with the vast majority of deaths (72% to 78%) and hospitalizations (55% to 100%). Although the overall injury rate was low, equestrian athletes are at risk for serious injuries. Pediatricians should know the medical contraindications for participation in equestrian sports and encourage riders to obtain horse safety training and use protective headgear (helmets) approved by the American Society for Testing Materials when riding or working around horses. Pediatricians can play an active role in increasing public awareness of equestrian injuries and in reducing risk of injury.