We reviewed the records of 143 patients, two months to fifteen years old, who were seen at the Mayo Clinic between 1950 and 1991 because of an injury to the cervical spine. There was a clear demarcation between the characteristics of the injury of two age-groups. Children who were less than eleven years old had fewer injuries as a group, were most often injured in falls, tended to have a predominance of ligamentous injuries of the cephalic portion of the cervical spine, and had a high rate of mortality as a consequence of injury to the spinal cord. Children who were eleven through fifteen years old had more injuries as a group, were most often injured during sports and recreational activities, had a higher male-to-female ratio, were more frequently injured in the caudal portion of the cervical spine, and had a pattern of injury similar to that of adults. The age and sex-adjusted incidence was 7.41 per 100,000 population per year.