Purpose-To investigate injuries among children and adolescents who participate in downhill sports.Methods-We collected trauma registry data (January 1999-May 2006) from a level 1 pediatric trauma center with an average snowfall of 28 in (71 cm)/y. Cases were analyzed for injury mechanism, injury type, organ injured, Injury Severity Score, age, sex, and whether or not an operation was required.Results-There were 57 snowboarders and 22 skiers admitted during the study period. Forty-one (72%) of snowboarders and 16 (73%) of skiers required operations; 32 (56%) of snowboarders and 9 (41%) of skiers sustained fractures; and 14 (25%) of snowboarders and 6 (27%) of skiers sustained abdominal injuries. (P = NS for all comparisons). Serious splenic injuries were more common in snowboarders (14% vs 4%), but the difference was not statistically significant. All skiing injuries occurred at recreational facilities (commercial skiing areas), whereas 12% of snowboard injuries occurred at home, other residence, or public parks (P = .08). The most striking finding is the rising number of snowboarding injuries and the relatively stable rate of skiing injuries (see graph).Conclusions-As the popularity of snowboarding rises, snowboarding injuries in children are increasing. Pediatric surgeons should be wary of the "snowboard spleen." Keywords Snowboard; Skiing; Recreation; Pediatric; Trauma Although downhill skiing is a well-established sport, snowboarding is relatively new: it was recognized by the International Olympic Committee in 1994 and premiered in the 1998 Winter Olympics in Nagano, Japan [1]. Snowboarding is remarkable for its dramatic rise in popularity [2] and its association with serious injuries [3]. The purpose of this study was to investigate skiing and snowboarding injuries at a level 1 pediatric trauma center that is located outside of the typical "snowbelt" in the United States.