In the September issue, we discussed pediatric cervical spine injuries, a number of which were caused by seat belts. Another case report has recently been published that details quadraplegia in a 6-year-old girl.

"A 6-year-old girl was the front-seat passenger in a four-door, midsized, late-model sedan, which was struck from the rear, on the right, by a truck. Impact speed was estimated at 35 miles per hour...The 6-year-old child was restrained by a lap-shoulder belt (three point restraint) seat belt." Fracture at C3-C4 was found, most likely due to severe hyperflexion over the seat belt.

The authors point out that federal regulations ignore children of this size, as they are larger than infants, and smaller than adults.

In less severe collisions, small children should be carefully evaluated after auto accidents to rule out musculoskeletal trauma.

Lynch JM, Meza MP, Pollack IF, Adelson PD. Direct injury to the cervical spine of a child by a lap-shoulder belt resulting in quadraplegia: case report. The Journal of Trauma 1996;41(4):747-749.