Background: Paediatric head injury is a common traumatic cause of morbidity mortality globally. Aetiological mechanism ranges from road traffic crash to falls depending on geographical location. Objective of the study: to describe the clinical pattern of paediatric head injury in our settings. Methods: A retrospective study of cases of head injury in children who had neurosurgical intervention in our centre between January 2013 to December 2017. Relevant clinical and radiological information was obtained from patient’s medical records and analysed. Results: We had 43 patients over the study period, males constituted the majority with a male–to–female ration of 2.9:1. Road traffic crash was the common cause of head injury (33/43) followed by fall into a well (6/43). The indications for neurosurgical intervention noted were open head injury (14/43), depressed skull fracture (11/43), epidural haematoma (7/43), subdural haematoma (2/43) and intraventricular haemorrhage (2/43). While the surgical operations included: debridement and duroplasty, elevation of depressed skull fracture, craniotomy and evacuation, burr hole drainage of liquefied collection and external ventricular drainage. Conclusion: Paediatric head injury commonly affects boys in our environment and resulted from road traffic crashes in most patients. There were few cases of fall in to water wells. Various indications for surgical intervention were observed including but not limited to open head injury, depressed skull fractures and intracranial haematomas.