During a 9-year period, 541 children were admitted with injuries sustained as passengers in motor vehicle accidents. Of these, seven (1.3 per cent) had the cervical seat belt syndrome. Five children had fractures or fracture-subluxations of the proximal cervical spine, while two had injuries of the lower cervical spine. Head injuries occurred in four children, severe cervical spinal cord injuries in three, while a fracture of the larynx and recurrent laryngeal nerve palsies occurred in one child. All children were wearing three- or four-point restraints. In the former group, the neck injuries probably resulted from flexion of the neck over the poorly fitting sash of an adult-type lap-sash belt, while in the latter group, the injuries probably resulted from hyperflexion of the neck while the torso was securely restrained. One child died from a severe head injury and a complete cervical cord injury. Satisfactory spinal alignment and stability were achieved in the surviving children by non-operative treatment. However, only three children recovered completely from their injuries. Two require continuing care for cervical spinal cord damage and one has persistent tracheal stenosis and paralysis of the vocal cords.