In a retrospective study we reviewed 262 horse riding related injuries in children younger than 16 which were treated between 1975 and 1989 at the Section of Traumatology in the Department of Surgery, University Hospital Homburg/Saar. In 155 of these accidents, detailed information was gained via a questionnaire. The typical patient profile was that of young female equestrians with little experience and little weekly riding practice, without practicing falling-exercises and warming up often using different horses. At the time of the accident only 59% were wearing a head protection. Most accidents happened in the summer months in the afternoon during leisure riding on a large familiar horse in the riding hall. Apart from the typical accidents like falling of the horse (64.9%) and falling with the horse (5.7%) accidents in handling the horse were of special significance: Kick by horse's hoof (11.8%), being stepped by horse (3.8%), horsebite (7.3%) and injuries of horse's bridle had their own pattern of injuries. Injuries of the distal parts of the upper extremity are preeminent in falling of the horse, whilst in falling with the horse head injuries and shoulder injuries are preeminent. Remarkably often injuries of kick by horse's hoof were causing sometimes even dangerous head injuries (41.6%). Overall in horse riding related injuries in childhood superficial soft tissue injuries (48.6%) and fractures (30.6%) were predominant. Fractures of the clavicle which are well known as a riding injury proved to be typical for a fall with the horse, whilst a fractured vertebra was only seen once amongst the 262 children treated. The severity of the injuries was lower than expected: In 85.1% of all the injuries only one body region was injured, 90.1% could be assigned to an injury severity score (ISS) of 1-3. Ponyriders had less severe injuries than riders of large horses. One fatal accident happened in handling a horse, in these situations preventive measures are often disregard. Active (better education, warming up, falling practice) an passive (head protection!) safety measurements are recommended for prevention of injuries in young riders in particular.