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In this article, we discuss pediatric cervical spine anatomy and congenital variants that may mimic upper cervical spinal injuries. In addition, we identify the imaging modalities and imaging utilization to evaluate cervical spine trauma. We review the role of plain radiographs and CT scans for bony and joint injuries and MRI for evaluation of ligamentous involvement and purely ligamentous injury. Finally, we illustrate, with case examples, injuries most often encountered in pediatric cervical spine trauma; and pitfalls, including ossification centers, variable degrees of fusion, and pseudosubluxation.