What is the recommended immobilization approach for suspected pediatric cervical spine injury in the prehospital setting?

• A. Manual in-line stabilization with appropriate pediatric-sized backboard and collar, maintaining neutral alignment.
• B. Fully immobilize with an adult-sized backboard and collar, regardless of size.
• C. Apply a rigid cervical collar but avoid any movement restrictions during transport.
• D. Do not immobilize; transport with head in a neutral position.

Answer: (A)

When a pediatric patient may have a cervical spine injury, the priority is to limit movement to prevent secondary spinal cord damage. The best approach is to use manual in-line stabilization while you prepare and apply equipment sized for the child, keeping the head and neck in a neutral alignment throughout transport. This respects the child’s anatomy, reduces the risk of movement with an ill-fitting device, and provides stable immobilization without compromising the airway. Maintaining neutral alignment means avoiding any rotation, flexion, or extension of the neck.

Once immobilization is secure with appropriately sized devices, continue careful transport with ongoing monitoring. Using an adult-sized backboard and collar or not restricting movement at all can lead to poor immobilization, discomfort, or further injury, and applying a collar without stabilizing the spine does not protect against movement.