To determine the utility of the routine cervical spine radiograph, we reviewed all cervical spine radiographs obtained in pediatric trauma patients over a 2 1/2-year period at the Childrens Hospital of Los Angeles. Records of patients admitted with a documented cervical spine injury over a 20-year period were also reviewed. One hundred eighty-seven children had at least one cervical spine radiograph. Forty-six patients (25 percent) required at least one repeat study in an attempt to see all 7 vertebrae. Thirty-eight children (20 percent) had a second radiograph and 8 patients had a third study, all of which showed no injury. There was only one fracture seen during the 2 1/2-year time period. Of the 16 children admitted over the 20-year period, only 3 sustained an injury below the fourth cervical vertebra (C4), and all were over 8 years of age. All patients with cervical spine injury were either comatose or had symptoms referable to the neck. We conclude that the routine cervical spine radiograph in pediatric trauma is a very low-yield test.