Vertebro-medullary injuries before the age of 15 years are a relatively rare occurrence, if compared to adults, in terms of trauma mechanics, treatment and follow-up. Overall, the incidence of severe traumas in infants and children is about 1:100 with respect to adults, and only 5% of traumatic paraplegia is encountered in infants and children. On the other hand, spinal cord injuries without fracture, which are extremely rare in adults, represent about 1/3 of the traumatic spinal cord injuries in infants and children. Complete spinal cord injuries are more often encountered in children, whereas they are observed only in 50% of the adults. The pathogenetic mechanism is often vascular with haemorrhage, generally resulting in flaccid paralysis. In children, spinal shock is shorter if compared to the 4 to 6 weeks observed in adults; very often, few hours are enough to see the sacral reflex restored. There are no significant differences between children and adults, except for the greater caution necessary when examining a child who won’t cooperate in the best way.