Pediatric cervical spine injuries differ from adult injuries because of a child's proportionately larger head, the presence of epiphyseal plates, and greater ligamentous laxity. Odontoid fractures are less common in adults (10%), but are the most common pediatric cervical fracture (up to 8 years of age). Most pediatric odontoid fractures occur at the epiphyseal plate. Physiologic ligamentous laxity results in pseudosubluxation of C2 on C3 and C3 on C4 (40% of children younger than 7 years have this finding). Those older than 12 years tend to have lower anatomical cervical injuries. Approximately 40% of patients with a cervical spine fracture have associated neurologic injury. Treatment of cord injuries may include methylprednisolone 30 mg/kg loading dose, followed by 5.4 mg/kg/h for 23 hours.