Objective: To study the types of injuries and the final outcome following childhood accidental falls from heights and to suggest possible preventive strategies. Design: Detailed histories of all children of 12 years and below seen during a 4-year period, after falling from heights, were obtained from the mothers and guardians. This was followed by a physical examination and appropriate radiological examinations. Results: Pre-school children constituted 83% with a male preponderance. In all 42% of falls were from the balconies of storied houses. Head injuries occurred in 70 (67%) and of these 46 (68%) had skull fractures. There was a significant incidence of fractures from falls of 4-6 metres and higher (p < 0.05). The study showed a mortality of 3% and 5% morbidity. Interventions: The authors suggest installation of metal grills or other protective material on the balconies and in the windows above the ground floor. Main outcome measure: Prior to the implementation of these protective measures, there is a need for the education of parents and guardians about the importance of close supervision of children under 6 years of age. Conclusion: Accidental falls from heights in children is highlighted as an important health problem in the Asir Region, Saudi Arabia.