Ninety-six children were admitted during a 9-year period to a pediatric level 1 trauma center for treatment of farm-related injuries. The age range was from 6 weeks to 17 years (median, 7.5 years; mean, 7.6 years; standard deviation, 4.4). Thirty-nine patients (40.6%) had an animal-related injury, including 36 children (37.5%) who had an injury associated with a horse. Amish children had an increased risk of horse-related injury when compared with non-Amish children (p=0.04; RR=2.09, 95% CI: 1.18<RR<3.70). Thirty-seven patients (38.5%) had farm machinery-related injuries, including 14 children (14.6%) with an injury associated with a tractor. Falls from buildings or haylofts accounted for injuries to 12 patients (12.5%). Head trauma accounted for 35 cases (36.4%), with skull fractures in 23 cases (24.0%). Animal-related injuries were significantly associated with head/maxillofacial trauma (p = 0.001; RR = 2.15, 95% CI: 1.35 <RR<3.41). Five children (5.2%) died, and one child with a severe brain injury was discharged to a long-term rehabilitation facility. Animals, especially horses, accounted for a large percentage of farm-related injuries in this population.