title: Neutral cervical spine positioning in children.
abstract: OBJECTIVE
  To determine the height of back elevation required to place the cervical spine of children less than 8 years old in neutral position and whether agreement on the height required for neutral position could be reached by two independent observers.
  
  
  METHODS
  Prospective.
  
  
  METHODS
  Pediatric emergency department and outpatient clinics.
  
  
  METHODS
  Convenience sample of children less than 8 years old.
  
  
  METHODS
  Independent placement of children in neutral position by two observers using standard sized padding with or without shims to raise the back off a backboard.
  
  
  RESULTS
  All children required elevation of the back for correct neutral position (mean height, 25.4 +/- 6.7 mm; range, 5 to 41 mm). Children less than 4 years old required more elevation than those > or = 4 years old (27 +/- 7.2 vs 22 +/- 4.2 mm, P < .05). Independent observer measurements were similar (mean, 25 +/- 8.0 vs 25.7 +/- 6.8 mm; interobserver kappa = .56).
  
  
  CONCLUSIONS
  Children less than 8 years old require back elevation to achieve neutral position while lying supine on a backboard. Also, independent observers can agree on what constitutes neutral position in most children.
authors.affiliation: Division of Pediatric Emergency Medicine, Henry Ford Hospital, Detroit, Michigan.
authors.forename: M
authors.initials: M
authors.lastname: Nypaver
authors.forename: D
authors.initials: D
authors.lastname: Treloar
mesh_terms: D002574:Cervical Vertebrae / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007103:Immobilization; D007223:Infant; D015588:Observer Variation; D011446:Prospective Studies; D013124:Spinal Injuries / Q000628:therapy*; D016683:Supine Position