There are more than 18,000 new reported spinal cord injury cases in the U.S. each year.¹ Spinal cord injuries (SCIs) in children can have profound implications for their overall health and quality of life. Approximately 20% of traumatic SCIs occur in people under 21,² most commonly as a result of motor vehicle accidents or falls. However, the incidence of spinal cord injury in children is relatively rare, accounting for about 2-5% of all spinal cord injuries, and the male-to-female ratio for pediatric spinal cord injuries is approximately 1.5:1, with a higher prevalence in males.
Understanding pediatric spine anatomy and development.
The pediatric spine is a remarkable and evolving structure, undergoing significant changes from infancy through adolescence. Understanding the unique anatomy and development of the pediatric spine is essential for accurately diagnosing and managing spinal cord injuries in children. The spinal cord, a vital bundle of nerves responsible for transmitting messages between the brain and the rest of the body, is encased and protected by the spinal column. In children, this spinal column is more flexible and resilient than in adults, which can sometimes help absorb trauma but also makes the pediatric spine more susceptible to certain types of spinal injuries.
One of the most important differences in the pediatric population is the vulnerability of the cervical spine. Due to a larger head-to-body ratio and less developed neck muscles, children, especially those younger than eight, are at higher risk for cervical spine injuries. This anatomical difference means that even minor motor vehicle accidents, falls, or sports injuries can result in significant trauma to the neck area. As children grow, the fulcrum of cervical mobility shifts lower in the spine, which changes the pattern and location of injuries as they age.
Spinal cord injuries in children can be classified as complete or incomplete, with incomplete spinal cord injuries being more common in the pediatric population. The American Spinal Injury Association (ASIA) provides a standardized system for assessing the severity of these injuries, which helps guide treatment and predict outcomes. Incomplete injuries often allow for some preservation of sensory and motor function, offering a better chance for neurological improvement with appropriate care.
A traumatic incident, such as a car accident or a significant fall, can cause a primary injury to the spinal cord, resulting in immediate damage. Secondary injury occurs in the hours and days following the initial trauma, often due to factors like low blood pressure, lack of oxygen, or infection. Spinal shock (a sudden loss of spinal cord function) can develop after injury and is considered a medical emergency, as it can be potentially life-threatening if not managed promptly.
Diagnosing spinal cord injuries in children requires a thorough physical examination, with careful assessment of sensory and motor function, muscle strength, and voluntary muscle movement. Symptoms such as muscle weakness, loss of movement, and changes in bowel and bladder function are common indicators of spinal cord involvement. Magnetic resonance imaging (MRI) is a critical tool for visualizing the spinal cord and detecting injuries that may not be visible on X-rays. Blood tests and other imaging studies help confirm the diagnosis and identify any associated injuries, such as head trauma or internal bleeding.
Because the entire spine can be affected, it is essential to evaluate for additional injuries, including head injury, cervical strain, and other potentially life-threatening injuries. Prompt emergency medical attention is crucial to stabilize the child, manage blood pressure, and prevent further damage to the spinal cord. Early intervention by a multidisciplinary team — including pediatricians, neurologists, and rehabilitation specialists — can make a significant difference in outcomes.
Rehabilitation services, such as physical and occupational therapy, are vital components of recovery for children with spinal cord injuries. Pediatric rehabilitation focuses on restoring motor function, improving muscle strength, and helping children regain independence in daily activities. With timely and comprehensive care, many children experience significant neurological improvement and can achieve a better quality of life.
Understanding the anatomy and development of the pediatric spine, along with the mechanisms of injury and best practices for management, is key to providing optimal care for children with spinal cord injuries. At Nexus Health Systems, our team is dedicated to supporting each child and family through every stage of recovery, ensuring the best possible outcomes for our young patients.
Why pediatric spinal cord injury is different.
Pediatric spinal cord injuries are complex, and the rehabilitation that is required to treat the diagnosis varies among cases. Children who sustain a spinal cord injury may face numerous challenges as a result of their injury such as chronic pain, dysfunctional bladder and bowels, and respiratory issues. It is common among pediatric cases for the cervical spine to be affected, much more so than in adult diagnosis, which often results in partial or full paralysis of the trunk and extremities. Since pediatric patients have thinner skin and increased skin elasticity, they are also more susceptible to wounds associated with the event of the injury. The term ‘cord injury in children’ encompasses these unique challenges, as children with SCI develop complex, lifelong medical and psychosocial consequences that differ significantly from adult-onset injuries.
In addition to physical treatments to address their injuries, pediatric patients also many times require support for emotional and behavioral reactions to their situation. While the adolescent body may be suffering from an injury, many times the mind is not. For physicians and clinical staff, this means that in common cases, children will still want to be children. When looking at children compared to adults, it is important to recognize that children with SCI face increased risks of depression and anxiety due to social isolation and disruption of normal routines. The patient and his/her family or caregiver could require more counseling, training, and simply time to adjust to injury and long-term deficits based on the child’s developmental stage.
It is important to consider the perspective of the child throughout their rehabilitation process. ASIA research has found some discrepancies between how children being treated for spinal cord injuries report how they’re doing, and how parents interpret their progress. Providing some sense of input and control can be a critical step in the progression of therapy and follow-up compliance.
Nexus Children’s Hospital considers each child individually at our Houston campus in a family-focused setting. The recovery journey is different for all spinal injury patients, and our experienced medical and allied health professionals work as a cohesive team to develop patient-centered, customized treatment plans that evolve as our young patients progress.
The Rise Program: A pediatric spinal cord injury program at Nexus Children’s Hospital.
At Nexus Children’s Hospital, treatment and therapy protocols are tailored to each patient’s level of injury and rehabilitation needs determined by the American Spinal Injury Association Impairment Scale exam.
“Treatment is not prescriptive, rather the individualized plans are creative and motivating, and ultimately, more effective at helping improve and support a child’s maximum functional potential. Our program helps children make meaningful progress,” explains Dr. Courtney Toomey, Physical Medicine and Rehabilitation Physician and Director of Rehabilitation Programming.
The program has multiple elements developed to help children progress through their spinal cord injury recovery. Treatment plans and goals are adjusted depending on the patient’s level of injury, responsiveness to care, and medical conditions. Pediatric patients may receive therapy up to three times per day including physical, occupational, and speech therapy. Physical therapy is a key component of rehabilitation for pediatric spinal cord injury, focusing on restoring function, managing spasticity, and improving overall outcomes. Rehabilitation strategies for pediatric spinal cord injuries are designed to maximize functional recovery and quality of life, but research in this area is still limited compared to adult populations. A full interdisciplinary team collaborates on each pediatric case including physicians and medical staff, dieticians, physical, occupational, and recreational therapists, neuropsychologists, speech-language pathologists, and case managers.
Once sensory and motor levels are assessed, the rehabilitation team customizes treatment to work towards functional goals. Tracking neurologic improvement is an important part of the rehabilitation process, as it helps document changes in motor, sensory, and reflex functions over time. Each child’s plan is approached with a truly individualized structure, for example, considering if the individual is paraplegic, tetraplegic, or complete. Progressive assistance always includes activities of daily living, as well as additional tasks such as mobility, transfer training, orthotic fitting, strength and endurance training, respiratory conditioning, custom medical equipment, or even electrical stimulation for neuromuscular re-education and strengthening.
Long-term care for children with spinal cord injuries requires ongoing involvement from the child’s doctor. Long-term care considerations include frequent medical evaluations and diagnostic testing to monitor progress after hospitalization and rehabilitation, ensuring comprehensive oversight and support for continued recovery.
Family and caregiver support is essential.
In the Rise Program at Nexus Children’s Hospital, collaborative teams meet twice per week to discuss individual care plans to maximize recovery potential and minimize barriers of our adolescent spinal cord injury patients. The care plans also include and address caregiver concerns and support plans.
Evidence from pediatric spinal cord injury research demonstrates that multimodal caregiver interventions — combining skill development, education, psychosocial support, and referral to mental health resources — are associated with improved caregiver coping, preparedness, and overall family adjustment.³ Intentional focus on caregiver preparedness commonly results in reduced negativity surrounding the adolescent patient’s diagnosis, demonstration of effective problem-solving skills, and increased sense of a supportive community.
At Nexus Children’s Hospital, families and caregivers complete training and education throughout the duration of a pediatric patient’s admission, treatment, and rehabilitation. All training and education is tailored to the patient’s level of spinal cord injury, medical requirements, and caregiver capabilities. Our teams are dedicated to equipping families and caregivers with the tools and knowledge to confidently continue to support and care for their child at home.
