Pediatric spinal immobilization

August 28, 2013 by Chris Darr
I’m looking for some direction or recommendations on spinal immobilization on a child?      – Elizabeth, Colorado Springs

Thank you for your question. Children have a large occiput compared to their chest circumference and thus spinal immobilization will often force their neck into kyphosis. By age 8 the pediatric cervical spinal cord differences have diminished and the patient can be immobilized and evaluated as an adult. Optimal immobilization of the cervical spine requires a spine board, hard cervical collar, soft spacing devices, and straps or tape to secure the patient to the spine board. The head and neck must be kept in neutral position or slight extension. If the spine board does not have a cut out to accomodate a child’s large occiput, then a pad usually 1 inch thick can be placed under the patient’s torso to keep the neck in a neutral position when secured to the spine board. Soft spacers are available commercially or can be rolled towels or IV bags. Sand bags are not recommended as they can injure the patient. Hard collars must be sized correctly. A hard collar that is too short allows neck flexion and one that is too tall causes hyperextension. If you do not have a hard collar for infants they can be immobilized in a car seat using lateral spacers and by taping in an “X” across the forehead to the sides of the carseat. This techniques should not be used in an infant with multiple injuries, has airway compromise or is unstable.

3 thoughts on “Pediatric spinal immobilization

  1. Audrey Jennings says:
    September 2, 2013 at 4:36 pm
    It is no longer recommended to immobilization a child in the car seat . It is impossible to ensure the integrity of the seat for immobilization. And most importantly the child has a very large head which causes axial loading on the spinal column when they are sitting up in the seat (which could compromise the spine)–this is something we are attempting to avoid when we immobilize the child. So lets take those kids out of the seat and immobilize them–it is easy to tip the seat on it’s back, cut the straps on the car seat and slide the child on the immobilization device of your choice.

  2. Bill Hall, MD says:
    September 6, 2013 at 3:26 pm
    Dr. Darr is correct in her description of proper immobilization techniques. However, there is a national movement which has been going away from using spine boards as “precautionary” immobilization technique. There to date have been no studies which have shown that a rigid spine board provides any additional protection for adults, and absolutely none for pediatrics. There are many studies showing the detrimental effects of rigid boards on respiratory mechanics, and of course decubitus ulcer formation. The ultimate goal is to halt any further stress to the spinal column which may be accomplished in many cases by gentle handling and having the patient lie still. Most protocols which have been developed to decrease the use of rigid spine boards have not spoken to age requirements. If the patient must be immobilized completely, vacuum splints are preferred. If you don’t have a vacuum splint then Dr. Darr’s method is preferred.

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