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The sport of rock climbing has recently gained in popularity due in part to its adoption by noncompetitive athletes as a physical activity with a level of intensity that can be self-regulated. However, the epidemiology of rock climbing injuries is poorly described at the national level. We report demographic and injury characteristics from 85,235 national weighted estimates of rock climbing injuries presenting to United States (US) emergency departments (EDs) between 2000 and 2019 in the National Electronic Injury Surveillance System, stratifying by whether patients were ≤18 years of age (A) or ≥19 years of age (B). The national weighted estimate of patients presenting to US EDs with injuries associated with rock climbing rose significantly (p < 0.001) from 2000 (2,667, CI 1,777–3,557) to 2019 (7,087, CI 4,544–9,630). Patients ≤18 years of age were significantly less likely to be male (A: 56.3%, CI 52.0–60.6%; B: 64.7%; CI 60.4–69.0%; p = 0.003), sustain injuries on weekends (A: 29.8%, 24.5–35.1%; B: 64.7%, CI 60.4–69.0%; p = 0.002), or sustain injuries during summer seasons (A: 26.6%, CI 22.1–31.1%; B: 33.2%, CI 28.1–38.3%; p = 0.049). Multivariate logistic regression demonstrated that patients ≤18 years of age were significantly more likely to present to EDs with head and neck (OR: 1.52, CI 1.04–2.21; p = 0.032) or upper extremity (OR: 1.55; CI 1.24–1.93; p < 0.001) injuries associated with rock climbing. We identified a significant increase in the annual estimated number of patients presenting to US EDs with rock climbing injuries compared to what has previously been reported. As the number of climbers continues to grow, standardized safety policies may be implemented that specifically target injury mechanisms and patterns unique to both adult and pediatric populations. [ABSTRACT FROM AUTHOR]