During 2006-2007, a midwest pediatric level I trauma center and affiliated urgent care centers treated 181 children for sledding-related trauma. Twenty-one children required hospitalization for injuries. Some children sustained injuries that were severe including cervical fracture with spinal cord injury, splenic laceration, pulmonary contusion, and head injury. The most frequent mechanism of injury was collision with an object or a person. Although most injuries are minor, some are serious and may have life-changing outcomes. Sledding in unobstructed areas may decrease injuries. An increased public awareness of the risks of serious injury associated with sledding is needed.