Pediatric spinal cord injury remains a relatively rare condition relative to its prevalence in the adult population. However, up to 5% of spinal cord injuries occur in children. In addition, age-related biomechanical and behavioral distinctions often make the detection and treatment of spine injuries in children much more challenging than in adults (1). For instance, one type of injury almost unique to children is spinal cord injury without radiographic abnormalities (SCIWORA), which by definition is more difficult to detect and therefore to treat than most adult injuries. Also, whereas neck pain is often the hallmark of spinal column injuries in adults, detecting this in a young child is a diagnostic dilemma and challenges even the most senior clinicians. Transport and management issues for the injured child also offer distinctions and challenges compared with adults. In this article, the subtleties of pediatric spinal cord injury are discussed, with a focus on the issues of diagnosis and management. EPIDEMIOLOGY