Falls in urban setting are a common cause for emergency room visits in children and adolescents. In a retrospective review, the charts of 48 patients admitted between 1980 and 1985 with a history of a vertical fall from a height were examined. In comparison, a previous review from the same institution disclosed that 66 patients were admitted because of a vertical fall from a height between 1965 and 1974, suggesting an increase of 37.5%. Most children fell from heights of 12 ft or less, although an increasing proportion of children in our series (33%) fell from heights of 36 ft or less. Sites included windows, walls, and roofs. The peak age of incidence has increased from 2 to 6 years; however, the mean age of children in whom significant injury occurred was 7.5 years, with only 27% of children under 3 years of age suffering a documented injury, as opposed to 67% of children over 3 years of age. Children are more apt to suffer a fracture than any other injury, most likely a fracture of the ulna and/or radius. Although hospital costs are high, mortality rates (2%) and the incidence of long-term sequelae (4%) are low. In conclusion, falls in the urban setting continue to be a significant public health problem, particularly in the 6- to 7-year age group.