Multiple noncontiguous injuries of nonadjoining regions of the spine in children are rare. Such injuries can be overlooked as the neurological deficit caused by one injury can be masked by the other. The combination of atlantooccipital dislocation and a seat-belt injury of the spine in children is rare. We describe an unusual case of atlantooccipital dislocation in combination with a seat-belt injury of the lumbar spine in a surviving child. Early halo-vest immobilization was an effective treatment in this patient. Although survival with atlantooccipital injuries is becoming common, severe and persistent neurological deficits can result in high morbidity. A brief description of the pathomechanics, diagnosis and treatment of the atlantooccipital dislocation and lumbar seat-belt injury is given.