Objecatives: Children on farms experience high risks for fall injuries. This study characterized the causes and consequences of fall injuries in this pediatric population. Methods: A retrospective case series was assembled from registries in Canada and the United States. A new matrix was used to classify each fall according to initiating mechanisms and injuries sustained on impact. Results: Fall injuries accounted for 41% (484/1193) of the case series. Twenty percent of the fall injuries were into the path of a moving hazard (complex falls), and 91% of complex falls were related to farm production. Sixty-one percent of complex falls from heights occurred while children were not working. Fatalities and hospitalized injuries were overrepresented in the complex falls. Conclusions: Pediatric fall injuries were common. This analysis provides a novel look at this occupational injury control problem.