OBJECTIVE The purpose of this study was to analyze impalement injuries of the oral cavity in children. METHODS Data on 144 children with impalement injuries in the oral cavity at the Department of Oral and Maxillofacial Surgery, Nara Medical University were analyzed retrospectively. RESULTS The patients were 93 boys and 51 girls (age range, 7 months to 10 years). One hundred thirty-two patients (91.7%) were younger than 5 years. Injuries occurred frequently by falling onto an object held in the mouth in 77 patients (53.5%). The impaled objects were a toothbrush in 30 patients (20.8%), a cylindrical toy in 27 (18.8%), and chopsticks in 19 (13.2%). The soft palate was frequently involved in 64 patients (44.4%), followed by the hard palate in 26 (18.1%). Computed tomographic examination was performed in 16 patients (11.1%). Observation with or without medication was most frequently chosen in 98 patients (68.1%). Surgical intervention was performed in 46 patients (31.9%), 41 under local anesthesia and 5 under general anesthesia. Admission was required in 12 patients (8.3%). No complications, such as deep infection or neurologic sequelae, were observed. CONCLUSIONS Most impalement injuries in the oral cavity in children heal spontaneously or with minimal intervention. These children can be followed on an outpatient basis with instructions to their parents about possible complications, except for a few selected cases.