Early airway management should be considered for patients with facial and neck burns, including from ingested caustic substances For circumferential burns, an escharotomy may be indicated which involves a vertical incision from the chin to the superior aspect of the sternal notch This should only be performed by an experienced provider familiar with pediatric neck anatomy (see Chapter 104 Burns ) In blunt trauma, progressive onset pain, irritability, and signs of cord compression may suggest a spinal (usually venous) epidural hematoma Rapid assessment by CT or MRI, followed by surgical intervention, will help ensure optimal outcome Clinically unstable patients should be considered for emergent operative intervention Clinical Indications for Discharge or Admission The patient can be discharged if they not have a significant injury, are hemodynamically stable, without any airway compromise, able to tolerate oral intake to maintain their hydration, and no indication or risk of abusive trauma or neglect is present Otherwise, admission is indicated CERVICAL SPINE TRAUMA Goals of Treatment The goals are to identify cervical spine injury and prevent progression of secondary injury by applying the principles of spine immobilization and acute trauma resuscitation to maintain adequate ventilation, oxygenation, and hemodynamic status CLINICAL PEARLS AND PITFALLS Cervical spine injuries are uncommon in children but account for the majority of vertebral injuries in children Younger children tend to have higher proportion of upper cervical spine injuries (C1–C3) due to the higher fulcrum of the immature spine, dislocations instead of fractures, and spinal cord injury without radiographic abnormality (SCIWORA) Children with congenital spine abnormalities, osseous weakness, or ligamentous instability are at increased risk for spinal injury Airway management should be accomplished with simultaneous stabilization of the cervical spine