Abstract: Background: Childhood injuries are a major public-health challenge globally and constitute one of the leading causes of morbidity, disability, and mortality among children, particularly in low- and middle-income countries. Nepal faces a rising burden of pediatric injuries due to rapid urbanization, increasing road traffic, limited safety regulations, and inadequate injury-prevention programs. Provincial hospitals manage the majority of trauma cases; however, data describing pediatric injury patterns in these settings remain scarce. Methods: A retrospective descriptive cross-sectional study was conducted in the Orthopedics Department of MIHS Provincial Hospital, Nepal. Medical records of 468 children aged below 18 years presenting with injuries between May and October 2025 were reviewed. Data on demographics, mechanism of injury, anatomical site, injury type, and treatment outcomes were extracted using a structured checklist. Descriptive statistics were calculated, and associations between variables were analyzed using the chi-square test. A p-value < 0.05 was considered statistically significant. Results: Out of the 468 children, 304 (65.0%) were male and 164 (35.0%) females, with a mean age of 9.2 ± 4.6 years. The most affected age group was 5–14 years (52.1%). Falls (44.9%) were the most common mechanism of injury, followed by road-traffic accidents (RTAs) (29.7%), burns (11.5%), and other causes (13.9%). Upper-limb injuries predominated (36.3%), followed by lower-limb (25.6%) and head injuries (21.8%). Fractures accounted for 48.1% of all injuries. A statistically significant association was observed between age group and mechanism of injury (χ² = 26.4, p = 0.001) and between sex and type of injury (χ² = 8.9, p = 0.031). Most children (71.2%) were discharged after initial management, while 26.5% required admission. Conclusion: Pediatric injuries in this provincial hospital predominantly affected school-aged boys and were largely caused by falls and RTAs. Upper-limb fractures were the most frequent orthopedic injuries. Strengthening injury-prevention strategies, improving home and road safety, and enhancing pediatric orthopedic trauma services are essential to reduce the burden of childhood injuries in Nepal.