Objective. To describe the circumstances of fall-related injuries among youth 0-19 years treated in emergency departments in Nicaragua; to estimate the incidence rates (IR) of falls; and, to identify areas for prevention efforts. Materials and Methods. All patients <20 years who were residents of Managua, León, Jinotepe, and Ciudad Sandino (6 593) were selected for analysis. Data were collected with the 2004 Injury Surveillance System. Results. In 2004, the IR of falls for youth <20 years old was 104.2 incidents per 10 000 persons. The IR for male youth was twice that of female youth. Overall, trees (23.3%) and beds (15.2%) were the main objects involved in falls. Fractures were the leading injuries sustained. Conclusions. This study identifies three areas that can be addressed: furniture, recreation, and physical environment. Interventions that may be most useful for caregivers and adolescents include changes in the home environment and recreation play areas, as well as educational programs.