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 > 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).

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.