<b><i>Background:</i></b> Equestrian activities can be undertaken for competition or leisure. Accidents can lead to bodily injuries. In particular, traumatic brain injury (TBI) can be devastating. Limited data exist regarding the pediatric population with respect to patterns of injury and related neurosurgical intervention. <b><i>Methods:</i></b> We retrospectively reviewed data for all pediatric patients diagnosed with equestrian-related injuries with neurological injuries from 2005 through June 2015. <b><i>Results:</i></b> Nine patients (1 male and 8 females) had neurological injuries. Their mean age was 10.4 years (range 2.9-16.8 years). Intracranial pathologies ranged from small punctate hemorrhages to large surgical extra-axial hematomas. Five patients also had concurrent skull fractures; 2 exhibited open lesions. Two patients required a decompressive craniotomy with placement of an external ventricular drain. Three patients exhibited other minor injuries; none had thoracic/abdominal/pelvic injuries. At discharge, all had good recovery; 1 patient who had a craniotomy did have a persistent right third-nerve palsy. <b><i>Conclusion:</i></b> Equestrian activities can present with dangerous and unpredictable situations, which can lead to profound neurological injury. Caution should be observed for all involved members, as both riders and nonriders are susceptible to harm. Protective gear (such as helmets), adequate training, and extensive experience are encouraged.