• M Nypaver and D Treloar.
• Division of Pediatric Emergency Medicine, Henry Ford Hospital, Detroit, Michigan.
• Ann Emerg Med. 1994 Feb 1;23(2):208-11.

Study ObjectivesTo 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 DesignProspective.SettingPediatric emergency department and outpatient clinics.Type Of ParticipantsConvenience sample of children less than 8 years old.InterventionsIndependent 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 ResultsAll 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).ConclusionChildren 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.

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