Current Evidence Cervical spine injuries are uncommon in children, occurring in an estimated 1% to 2% of patients with multiple trauma The majority of injuries are a result of blunt forces Motor vehicle crashes are the most common mechanism across all age groups, with the highest risk injuries occurring in children who are unrestrained in high-speed collisions (head-on or roll-over) or ejected from the vehicle Other mechanisms include sports-related injuries for children older than years of age and falls for children younger than years of age For sports-related injuries, accidents with axial loading mechanisms and those that occurred during diving and football are associated with poorer neurologic outcomes Nonaccidental trauma should also be considered in younger children It is estimated that 5% of all spinal injuries occur in children younger than 16 years However, approximately 72% of spinal injuries in children younger than years occur in the cervical region Certain pre-existing conditions (Down, Maroteaux–Lamy, Morquio, Grisel, and Klippel–Feil syndromes; achondroplasia; congenital cervical stenosis; Chiari malformation; rheumatoid disease; and acute soft tissue or bony infection or infiltration) may result in a cervical spine more predisposed to injury with minor or more significant trauma Neurologic sequela may also occur in pediatric patients undergoing spinal manipulation for therapeutic purposes Neonatal spinal injury may result from birth-associated trauma and is reported in approximately in 60,000 births These patients often have a history of forceps use during delivery or abnormal head presentation causing neck hyperextension and may exhibit examination findings of weakness, flaccid quadriplegia, spinal shock, and apnea These birth-related injuries carry high morbidity and mortality CT or MRI is the preferred imaging modality The pediatric cervical spine and its evaluation differ in several ways from that of the adult cervical spine The fulcrum of the cervical spine of an infant is at approximately C2–C3 and reaches C3–C4 by to years of age At about to 10 years of age, the fulcrum (C5–C6) and other characteristics of the cervical spine approximate that of an adult The higher fulcrum of a young child’s spine in combination with a relatively larger head, weaker neck muscles, and poor protective reflexes accounts for 74% to 78% of injuries in younger children involving the upper cervical spine (occiput–C2) Older children and adults have injuries that more often (53%) involve the subaxial cervical spine (C3–C7) Neurologic disability can occur from cervical lesions at all levels, but high cervical cord injuries are more likely to be fatal than are lower cervical cord injuries due to respiratory compromise