Falls from low heights, such as from a counter top or a shopping cart, are common in childhood. Caregivers are often concerned about the possibility of a head or neck injury and seek medical evaluation. Advanced Trauma Life Support guidelines for adults instruct that the cervical spine is “cleared clinically” if there is no pain on palpation, no limitation in range of motion and neurologic findings are normal in a patient without distracting injuries. Cervical spine injuries in children are uncommon. There are no guidelines for evaluating children with potential cervical injury. Yet physicians routinely obtain radiographs even though they are technically difficult and costly. Schwartz and associates conducted a retrospective review of the medical records of children with a diagnosis of cervical vertebral or cord injury to determine if historical and physical examination data adequately identify cervical spine injuries in young children after falls from low heights.

Study participants included children under the age of six years who had a documented fall of five feet or less. Only eight children were identified at the four participating institutions in chart reviews spanning six to 20 years. Seven of the children were boys. The most common diagnoses were rotary subluxation of C1 (three patients) and subluxation of C1-C2 (three patients). All eight children had neck pain or limited range of neck motion. No child presented with permanent neurologic deficit.

Cervical spine injuries in children are most often associated with a significant impact such as a high-speed motor vehicle crash. These children usually have multiple associated injuries. Falls from low heights are a much less frequent cause of cervical spine injuries. Radiographs are difficult to obtain in young children, and proper imaging of the upper cervical spine is particularly difficult because of lack of cooperation. Special expertise is needed to read radiographs in young children. Computed tomography may be more accurate but is more expensive and may require the use of sedation, thus prolonging evaluation time.

The authors conclude that cervical spine injuries sustained from falls of less than five feet are extremely rare. When injuries did occur, the child presented with clinical evidence of injury, including neck pain or limited cervical range of motion. Radiographic evaluation of the cervical spine in asymptomatic children who present after a fall from a low height may not be necessary.