During the winter season of 1985 to 1986, 30 children presented to the emergency department with injuries related to downhill sledding. All of the patients were seen and treated during December 1985, which was an unusually cold and snowy month. The age range of the patients was six to 16 years. Six patients required admission, and all were related to head and/or abdominal trauma. The special characteristics of the sled, the environment, and the rider work in concert to produce injuries. The injury is most likely to occur under cold, icy conditions. After analysis of this series of patients, it is concluded that downhill sledding injuries can be minimized. The factors that make this activity dangerous are defined, and safety precautions are suggested.