Head injuries account for approximately one third of all sledding-related ED visits, and the head and neck together represent the region of the body most frequently injured in sledding accidents. It is estimated that 53% of all related head injuries could be addressed by helmet use. While helmet use during downhill skiing and snowboarding has increased over the past decade, little attention has been paid to helmet use among recreational sledders. A retrospective chart review was conducted with 147 patients ages 5-19 (mean age 13.2 years, 66% male) treated in the ED for injuries sustained while skiing, snowboarding or sledding. Preliminary analysis revealed that overall, patients that were not wearing a helmet during their activity had significantly more head injuries compared to those wearing a helmet (p<.003). Analyses of the data for head injury by helmet use, controlling for activity showed a significant overall increase in head injury for snowboarders not wearing a helmet compared to skiers or sledders (p<0.0005). Interestingly, only one sledding patient in the sample wore a helmet. However among sledders, 52.27% suffered a head injury while not wearing a helmet while the single patient who wore a helmet (2.27%) did not suffer a head injury. When comparing this to the percentage of snowboarders (18.2%) and skiers (24.4%) who did not suffer a head injury while wearing a helmet the need for helmets during sledding becomes obvious.