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.