BACKGROUND: Individuals who sustained traumatic brain injuries in childhood may experience global challenges including disorders of consciousness, motor dysfunctions, and sensory impairments. Occupational and physical therapy are important parts of recovery from an acute brain injury, addressing deficits that directly affect functional recovery and return to age-appropriate activities of daily living. Difficulty with active engagement in therapy tasks can limit the effectiveness of therapeutic interventions. Therapists search for methods to increase patient engagement to bolster patient progress. OBJECTIVE: To examine the effect of animal-assisted interventions on patient engagement and therapy participation in children with traumatic brain injuries. DESIGN: Prospective, crossover design observational study with each patient serving as their own control. SETTING: This study was conducted in a pediatric acute rehabilitation unit. PARTICIPANTS: Nine participants completed all study sessions. INTERVENTION: Study participants completed four visits, two with animal-assisted intervention and two without animal-assisted intervention. OUTCOMES AND MEASURES: The Pediatric Rehabilitation Intervention Measure of Engagement, length of session, breaks needed. RESULTS: The use of animal-assisted intervention resulted in significantly greater mean engagement scores and significantly greater affective and behavioral engagement scores. No significant differences were found with cognitive engagement score, length of session tolerated, or number of breaks required. No participants had decreased engagement when animal-assisted intervention was used. CONCLUSIONS: Animal-assisted intervention has the potential to increase therapy engagement in acute rehabilitation with children recovering from traumatic brain injuries.