Significant differences exist in the anatomy and biomechanics of the pediatric spine in comparison to the adult spine. These unique anatomical characteristics and behavioral differences predispose the developing child to unique spinal injury patterns. These differences must be considered when managing spinal and spinal cord injuries (SCIs) in the pediatric population. Children less than 8 years of age are more prone to upper cervical spine injuries. After this, the maturational growth and development with regard to spinal anatomy reflect the transition to injury patterns characteristic of the adult patient. Although the prevalence of SCIs is lower in children, diagnosing subtle spinal injuries is often more difficult. This is especially true in light of the often unappreciated radiographic differences between an immature and mature spinal axis and the difficulty in obtaining an accurate physical examination in the child. The increased healing potential of the pediatric osteoligamentous structures represents another important and unique characteristic of the immature spine. Nonoperative strategies using various forms of external immobilization for injury patterns requiring surgical intervention in the adult may often be used with success in the pediatric population. Surgery on the growing spine, however, invokes concern regarding the potential for subsequent growth abnormalities, which is compounded by any disturbance related to the initial trauma. This article provides a review of the unique aspects of pediatric spinal anatomy, SCI mechanism patterns, and treatment options available for pediatric spine injuries along with their documented long-term outcomes.