NEUTRAL CERVICAL-SPINE POSITIONING IN CHILDREN

Study objectives: 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. Study design: Prospective. Setting: Pediatric emergency department and outpatient clinics. Type of participants: Convenience sample of children less than 8 years old. Interventions: 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. Measurements and 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 greater than or equal to 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). Conclusion: 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.