Background and objectives: Injury patterns in bicycle accidents may vary depending on patient age and mechanism of accident. We aimed to investigate characteristics of patients involved in bicycle accidents, along with mechanisms of accidents and clinical outcomes in children. Methods: Children admitted to the pediatric emergency department of a tertiary referral hospital during a four-year period due to bicycle accidents were included. The mechanism of accident was classified into two groups; high-energy trauma and low-energy trauma. Statistical analyses were performed to recognize injury patterns and clinical outcomes associated with mechanism of accident. Results: 360 children were included. 2 patients were using helmet. 29 patients required surgery. 14 patients had clinically important traumatic brain injury. 8 and 2 patients had permanent neurologic sequela and finger amputation, respectively. In high-energy trauma, significantly more commonly affected anatomical areas compared to low-energy trauma were extremities, head and neck, and multiple injuries. Abrasions/soft tissue injuries, scalp fractures, maxillofacial fractures and traumatic brain injury were also significantly more common types of injury in high-energy trauma. Conclusions: In a retrospective cohort with low rate and no obligatory regulation of helmet use, high-energy bicycle accidents can cause significant clinical outcomes, including maxillofacial and scalp fractures, traumatic brain injury, and permanent disability.