We reported a 12-year-old boy with neck pain and dysphagia 6 days after his neck being tied by another boy’s arms from the back. The boy was found to have a tear-drop fracture of the axis in both radiograph and MRI, which was a rare case in children. He was placed in a cervical traction with Glisson belt and received transfusion for 2 weeks until his neck pain and dysphagia were released. Thereafter, an operation of anterior fusion and fixation was chosen to ensure further stability of the cervical spine and replacement of the fracture fragment. An 8-year follow-up examination showed a satisfactory range of motion of the cervical spine, fusion at C2–3 intervertebral space, and normal signal of C3–4 intervertebral disk. We conclude that tear-drop fractures of the axis in children may be caused by extension injury without a high-energy trauma, and operation of anterior fusion and fixation can be the treatment of choice.