Children have a disproportionately larger head size
than adults, and when supine on a firm surface will
be in a position of slight flexion. This slight degree
of flexion is rarely a problem, though it can give rise
to difficulties in X-ray interpretation. This can be
corrected by placing a folded towel or sheet under the
patient's shoulders to bring the cervical spine into
the neutral position.
It may be difficult to immobilise a child adequately.
Distress and discomfort may require that manual in-line
stabilisation is used instead of a semi-rigid collar,
blocks and tape. Collar sizing may be difficult and
there are no collars that adequately fit infants aged
6 and below.
Clinical clearance of the spine is less well established
in the paediatric population. While the NEXUS study
(Vicellio) has shown promise in this area, of 3065 patients
there were only 4 cervical spine injuries in patients
under 9 years of age, and none below 2 years old.
The immature anatomy of the paediatric cervical spine
requires some expertise and familiarity to interpret
and to avoid missed injuries. Due to the paediatric
patients' larger head size, pseudosubluxation of C2
on C3, and anterior translations may appear as injuries
rather than as consequences of mild flexion.
Baker C, Kadish H, Schunk JE. Evaluation of pediatric
cervical spine injuries. Am J Emerg Med 17:230-4,
Brown RL, Brunn MA, Garcia VF. Cervical spine injuries
in children: a review of 103 patients treated consecutively
at a level 1 pediatric trauma center. J Pediatr
Surg. 2001 Aug;36(8):1107-14
Curran C, Dietrich AM, Bowman MJ, Ginn-Pease ME, et
al. Pediatric cervical-spine immobilization: achieving
neutral position? J Trauma 39(4): 729-732, 1995
Herzenberg JE, Hensinger RN, Dedrick DK and Phillips
WA. Emergency transport and positioning of young
children who have an injury of the cervical spine. The
standard backboard may be hazardous. J Bone Joint
Surg [Am] 71(1): 15-22, 1989
Jaffe DM, Binns H, Radkowski MA, Barthel MJ, et al.
Developing a clinical algorithm for early management
of cervical spine injury in child trauma victims.
Ann Emerg Med 16(3): 270-276, 1987
Keenan HT, Hollingshead MC, Chung CJ, Ziglar MK. Using
CT of the cervical spine for early evaluation of pediatric
patients with head trauma. AJR Am J Roentgenol.
Kokoska ER, Keller MS, Rallo MC, Weber TR. Characteristics
of pediatric cervical spine injuries. J Pediatr
Surg. 2001 Jan;36(1):100-5.
Nitecki S and Moir CR. Predictive factors of the
outcome of traumatic cervical spine fracture in children.
J Pediatr Surg 29(11): 1409-1411, 1994
Patel JC, Tepas JJ 3rd, Mollitt DL, Pieper P. Pediatric
cervical spine injuries: defining the disease. J
Pediatr Surg. 2001 Feb;36(2):373-6
Rachesky I, Boyce WT, Duncan B, et al: Clinical
prediction of cervical spine injuries in children. Radiographic
abnormalities. Am J Dis Child 141:199-201, 1987
Skellett S, Tibby SM, Durward A, Murdoch IA. Immobilisation
of the cervical spine in children. BMJ. 2002 Mar
Viccellio P, Simon H, Pressman BD, Shah MN, Mower
WR, Hoffman JR. A prospective multicenter study of
cervical spine injury in children. Pediatrics. 2001