The pediatric spine is more flexible than the adult spine, making it more resilient and therefore less susceptible to traumatic injury. The incidence of spinal column injury in children is low with rates varying from 1 to 5%. However, this increased flexibility contributes to the differing injury patterns seen in pediatric trauma when compared to the adult. In addition, due to physical and psychological immaturity, the clinical assessment and diagnosis can be extremely difficult. Significant head injury is a risk factor for cervical spine injury and any child with a suspected spinal injury should be immobilized in a hard cervical collar on a pediatric spine board. Since significant force is required to injure the spine, other regions may also be injured, with almost half of children having concomitant injuries.