What is a Cervical Collar?

A cervical collar, also called a neck brace or c-collar, is a medical device designed to support and limit the movement of a child's neck. The cervical spine consists of seven bones in the neck that are supported by ligaments and muscles. When there is an injury to this area, a cervical collar helps hold the neck in place to allow proper healing and prevent further damage.

Brief History of Cervical Collars

The cervical collar was invented in 1966 by George Cottrell during the Vietnam War as a way to provide neck immobilization for soldiers with potential unstable neck injuries. The device was designed to maintain the head in a neutral position and prevent secondary spinal cord injuries during transport and treatment.

Over the decades, cervical collars have evolved significantly. Early designs focused primarily on adults, but medical professionals soon recognized that children are not simply small adults. They have unique anatomical differences including incomplete bone development, greater ligament flexibility, and different body proportions. This understanding led to the development of pediatric-specific cervical collars in the 1980s and 1990s. Modern pediatric collars are now designed with input from healthcare providers who work with children, resulting in better-fitting, more comfortable, and more effective devices that account for the specific needs of growing bodies.

Purpose and Where They Are Used

Primary Medical Uses

• Trauma and Emergency Care: Used immediately after accidents, falls, or sports injuries where neck or head injury is suspected
• Post-Operative Support: Following cervical spine surgery or surgical procedures involving the neck area
• Fracture Stabilization: For stable cervical fractures that require immobilization during healing
• Cervical Spine Injuries: Supporting the neck when there is damage to the bones, ligaments, or soft tissues
• Torticollis: A condition where the neck muscles cause the head to twist or tilt to one side
• Whiplash and Strains: Supporting healing after mild to moderate neck injuries
• Muscle Weakness: Providing support for children with conditions affecting neck muscle strength

Common Settings Where Used

• Emergency departments and ambulances
• Pediatric intensive care units
• Hospital wards during recovery
• Home care during rehabilitation
• Physical therapy and rehabilitation centers
• Pediatric clinics and specialist offices

Types of Pediatric Cervical Collars

1. Soft Foam Cervical Collars

Construction: Made from soft to medium density foam covered with breathable cotton or hypoallergenic fabric.

Best For: Minor neck strains, whiplash injuries, mild torticollis, or as a reminder device to limit painful movements. Also used during recovery after wearing a rigid collar.

Features: Comfortable for extended wear, washable covers, adjustable with contact closures, lightweight design.

2. Semi-Rigid Cervical Collars

Construction: Made from medium-firm density foam with reinforced structures, often with adjustable features.

Best For: Moderate neck injuries, post-operative support, cervical spondylosis, herniated discs, or when more support than a soft collar is needed but full rigidity is not required.

Features: Better motion restriction than soft collars, adjustable height settings, removable padding for cleaning.

3. Rigid Plastic Cervical Collars

Construction: Two-piece design with hard plastic shells and padded foam liners, secured with straps.

Best For: Serious trauma, cervical fractures requiring stabilization, post-surgical immobilization, or unstable cervical spine injuries.

Features: Maximum immobilization, anatomically contoured for better fit, large opening at throat for airway access and pulse checking, removable washable pads.

Special Pediatric Designs

Pediatric cervical collars are specifically engineered for children with unique features including:

• Age-appropriate sizing based on anatomical measurements rather than just smaller adult versions
• Softer materials and padding to protect sensitive skin
• Shorter front height to accommodate smaller chin-to-chest distances
• Adjustable features to fit growing children
• Colorful designs and patterns to make them more appealing to children

How to Properly Measure and Size a Cervical Collar

Measuring Steps

For Healthcare Providers and Trained Caregivers:

• Neck Height Measurement: With the child's head in a neutral position, measure from the top of the shoulder to the angle of the jaw. Use your fingers or a measuring tool.
• Neck Circumference: Measure around the base of the neck where it meets the shoulders, keeping the tape snug but not tight.
• Chin to Collarbone Distance: Measure vertically from the bottom of the chin to the top of the collarbone at the center of the neck.

General Sizing Guide by Age

Step-by-Step Guide: How to Use a Cervical Collar

For Two-Piece Rigid Collars (Most Common Type)

Important: You need at least two people to safely apply or remove a cervical collar.

Application Steps

1. Prepare the Collar: Check that all pads are clean, in place, and properly attached. Ensure the collar is the correct size.
2. Position the Child: The child should be lying flat on their back on a firm surface without pillows. The head should be in a neutral position, facing straight up.
3. Assign Roles:
   • Person 1: Stands at the child's head and provides manual in-line stabilization by placing hands on both sides of the child's head and shoulders
   • Person 2: Applies the collar
4. Apply the Back Piece: Person 2 gently slides the back piece of the collar under the child's neck without lifting the head. Person 1 maintains head stabilization throughout.
5. Position the Front Piece: Place the front section so the chin rests comfortably on the chin support. The chin should reach the front edge of the chin piece but should not extend over it.
6. Secure the Straps: Connect the velcro straps from the back piece to the front piece on both sides. Tighten one strap at a time until snug but not too tight.
7. Check the Fit:
   • The chin rests on the chin support without sliding down
   • The collar is snug but allows normal breathing and swallowing
   • You can fit one finger between the collar and the child's neck
   • The head cannot move forward, backward, or side to side easily
   • No plastic edges touch the skin directly
   • The child can open their mouth if needed
8. Document Position: Note or photograph where the straps are positioned for future reference when removing and reapplying.

Removal Steps

1. Position Setup: Child should be lying flat. Two people are required.
2. Stabilize Head: Person 1 places hands on child's shoulders with forearms supporting the head on both sides. This person maintains this position until the collar is replaced.
3. Remove Front: Person 2 unfastens the straps and carefully removes the front panel.
4. Slide Out Back: Gently slide the back panel out from under the child's neck while Person 1 maintains head stabilization.
5. Care for Skin: Inspect the skin for any redness, irritation, or sores. Gently wash and dry the neck area with mild soap and water. Do not apply lotions or powders unless directed by a healthcare provider.
6. Replace Collar: Follow the application steps to put the collar back on within a few minutes.

For Soft Foam Collars

Soft collars are easier to apply but still require care:

1. Wrap the collar around the neck with the narrow part positioned under the chin
2. Secure the velcro closure at the back or side
3. Adjust for snug but comfortable fit
4. Ensure the child can breathe and swallow normally

Precautions and Safety Warnings

General Precautions

• Never apply a collar in acute trauma: Only trained emergency medical personnel should apply collars at accident scenes
• Proper sizing is critical: A collar that is too small can compress the airway or blood vessels; one that is too large provides no support
• Monitor skin regularly: Check skin under the collar at least twice daily for redness, irritation, or breakdown
• Keep it clean and dry: Moisture and debris can cause skin problems
• Follow wearing schedule: Wear the collar exactly as prescribed - not more, not less
• Do not modify the collar: Never cut, bend, or alter the collar in any way
• Watch for comfort issues: Children may not clearly communicate discomfort; watch for behavioral changes

Specific Risks to Monitor

When Not to Use a Cervical Collar

• If the child has an open wound or infection on the neck
• When the head cannot be positioned in a neutral, straight alignment
• If the child has a condition that makes collar use unsafe (discuss with doctor)
• When proper size is not available (improper size is worse than no collar for non-emergency situations)

Daily Care and Maintenance

Skin Care Routine

1. Morning and Evening Checks: Remove the collar (with help) twice daily to inspect skin underneath
2. Gentle Cleaning: Wash skin with mild soap and lukewarm water, then pat completely dry
3. Look for Problems: Check for any redness, irritation, pressure marks, or developing sores
4. Allow Air Time: Keep collar off for 5-10 minutes during skin care if healthcare provider approves
5. No Products: Do not apply lotions, powders, or creams unless specifically prescribed

Collar Cleaning

For Foam Pads and Covers:

• Hand wash in warm water with mild soap
• Rinse thoroughly to remove all soap residue
• Squeeze gently with a towel to remove excess water
• Air dry completely on a clean towel (do not use dryer or heat)
• Replace pads when they become worn, compressed, or damaged

For Plastic Components:

• Wipe with a damp cloth and mild soap
• Dry thoroughly before reapplying
• Check for any cracks or damage before each use

Bathing and Hygiene

For sponge baths with collar on:

• Use a damp washcloth to clean around the collar
• Be careful not to get the collar padding wet
• Pat skin dry immediately after washing
• Clean behind ears and under chin carefully

Sleeping with a Cervical Collar

• Child should sleep on their back on a firm, flat surface
• No pillow or only a very thin pillow if approved by doctor
• Keep collar on throughout the night unless instructed otherwise
• Ensure room is at comfortable temperature to prevent excessive sweating
• Check collar position after the child wakes up

Common Activities and Restrictions

What Your Child CAN Do

• Eat regular meals (may need to cut food into smaller pieces)
• Watch television or use devices positioned at eye level
• Do homework at a properly positioned desk
• Walk and perform gentle activities as approved
• Attend school if cleared by healthcare provider
• Ride in car with proper seatbelt positioning

What Your Child Should AVOID

• Contact sports or rough play
• Activities that require looking up or down repeatedly
• Heavy lifting or straining
• Swimming or water activities (unless specified collar is waterproof and approved)
• Running or jumping
• Riding bicycles, scooters, or skateboards
• Any activity where a fall could occur

Frequently Asked Questions

How long will my child need to wear the cervical collar?

The duration varies based on the injury or condition. Soft collars may be worn for a few days to 2 weeks, while rigid collars might be needed for several weeks to months. Your healthcare provider will determine the specific timeline and schedule follow-up appointments to assess healing progress.

Can my child sleep with the collar on?

Yes, in most cases children should keep the collar on during sleep unless specifically instructed otherwise by their doctor. The child should sleep on their back without a pillow or with only a very thin pillow.

What if the collar seems too tight or too loose?

Contact your healthcare provider immediately. A collar that is too tight can restrict breathing or blood flow, while one that is too loose will not provide proper support. Do not attempt to adjust the collar yourself without guidance.

Can my child go to school while wearing the collar?

This depends on the specific medical situation. Many children can attend school with a collar, but you will need clearance from your healthcare provider. The school should be informed of any restrictions, and physical education or sports activities will likely need to be avoided.

How often should we clean the collar?

Clean the removable pads daily if possible, or at minimum every 2-3 days. The plastic parts should be wiped down daily with a damp cloth. Always have a spare set of clean pads available.

Will wearing the collar weaken my child's neck muscles?

Extended use of a cervical collar can lead to some muscle weakening, which is why following the prescribed wearing schedule is important. Your healthcare provider may recommend physical therapy exercises after collar removal to restore strength and range of motion.

What if my child complains of pain while wearing the collar?

Some initial discomfort is normal as the child adjusts to wearing the collar. However, significant pain is not normal. Check that the collar is properly fitted and positioned. If pain persists or worsens, contact your healthcare provider.

Can the collar get wet?

Standard cervical collars should not get wet as the padding will become soggy and uncomfortable, and may cause skin problems. For bathing, either give sponge baths around the collar or follow your healthcare provider's specific instructions for collar removal during bathing.

Is it okay to take the collar off for short periods?

Only remove the collar when specifically instructed by your healthcare provider, such as during skin checks or cleaning. Never remove it for convenience or comfort without medical approval, as this could interfere with healing.

What should we do if the collar breaks or gets damaged?

Contact your healthcare provider immediately to get a replacement. Do not use a damaged collar as it will not provide proper support. Keep the damaged collar and bring it to your appointment.

My child keeps trying to remove the collar. What should I do?

Children may resist wearing the collar, especially younger ones. Try distraction techniques, explain its importance in age-appropriate terms, decorate it with stickers (avoiding straps and fasteners), and ensure it fits properly without causing unnecessary discomfort. If the child consistently removes it, discuss strategies with your healthcare provider.

Are there any signs that the collar is working incorrectly?

Warning signs include excessive movement of the head within the collar, collar sliding down or riding up, visible gaps between collar and skin, difficulty breathing or swallowing, or increasing pain. Any of these require immediate medical evaluation.

How to Keep the Device Safe and Functional

Storage Guidelines

• Store in a cool, dry place away from direct sunlight
• Keep away from heat sources which can warp plastic components
• Store flat or on a shelf, not compressed under heavy items
• Keep in original packaging or a clean bag when not in use
• Do not store near sharp objects that could puncture or damage foam

Regular Inspection Checklist

• Check all velcro straps for secure attachment and holding power
• Inspect plastic shells for any cracks, chips, or warping
• Examine foam pads for compression, tears, or deterioration
• Ensure all covers are intact without holes or fraying
• Verify that all parts fit together smoothly without forcing
• Check for any unusual odors that might indicate bacterial growth
• Replace any worn components before they fail

When to Replace

Get a new collar if:

• The child has outgrown the current size
• Any structural damage occurs to the plastic parts
• Foam padding has lost its shape or density
• Velcro no longer holds securely
• The collar has an odor that does not wash out
• Healthcare provider recommends replacement
• After completing treatment, do not save for future use as fit and function may have changed

Available Brands and General Cost Information

Multiple manufacturers produce pediatric cervical collars. Quality, comfort, and features can vary between brands. Your healthcare provider or medical equipment supplier will recommend appropriate options based on your child's specific needs.

Common Manufacturers

General Price Ranges

Costs vary significantly based on type, brand, and location:

Insurance Coverage: Many health insurance plans cover cervical collars when deemed medically necessary with proper prescription and documentation. Contact your insurance provider to understand coverage details.

Where to Obtain:

• Medical equipment suppliers
• Hospital or clinic medical equipment departments
• Specialized orthotic and prosthetic facilities
• Some pharmacies with durable medical equipment sections
• Online medical supply retailers (ensure proper sizing consultation first)

Physical Therapy and Rehabilitation

After wearing a cervical collar, especially for extended periods, children often benefit from physical therapy to restore normal neck function. Your healthcare provider will determine when rehabilitation should begin.

Common Rehabilitation Goals

• Restore normal range of motion in the neck
• Strengthen neck muscles that may have weakened
• Improve posture and body mechanics
• Reduce any residual pain or stiffness
• Gradually return to normal activities safely

What to Expect

Physical therapy typically includes gentle exercises, stretches, and activities designed for the child's age and condition. The therapist will teach exercises that can be practiced at home and will monitor progress over several weeks. Never start neck exercises without professional guidance, as improper movements could cause re-injury.

Follow-Up Care and Medical Monitoring

Regular Check-Ups

Your healthcare provider will schedule follow-up appointments to:

• Assess healing progress through physical examination
• Review imaging studies if needed (X-rays, MRI, or CT scans)
• Check collar fit as the child grows
• Adjust the treatment plan based on recovery
• Determine when the collar can be discontinued
• Provide guidance on return to activities

Signs You Should Contact Your Healthcare Provider

• New or worsening pain in the neck, shoulders, or head
• Changes in sensation (numbness, tingling) in arms or hands
• Weakness in arms or legs
• Persistent redness or skin breakdown despite proper care
• The collar no longer fits properly due to growth
• Questions about care or concerns about healing
• Child develops fever while wearing collar
• Any new symptoms that worry you

Special Considerations

For Infants and Toddlers

Very young children present unique challenges:

• Their heads are proportionally larger and heavier
• They cannot communicate discomfort clearly
• They may resist wearing the collar more actively
• Skin is more delicate and prone to breakdown
• They require more frequent monitoring
• Feeding may need to be adjusted

For Children with Special Needs

Children with developmental delays, sensory processing issues, or other special needs may require:

• Extra time and patience during application
• Modified approaches to gain cooperation
• More frequent skin checks due to communication challenges
• Collaboration between multiple healthcare providers
• Customized collars or alternative support methods

Cultural and Language Considerations

Ensure all family members who will care for the child understand:

• How to properly apply and remove the collar
• Warning signs to watch for
• The importance of compliance with the treatment plan
• When to seek medical help

Request translated materials or interpreters if needed to ensure clear communication about this important medical device.

Traveling with a Cervical Collar

Car Travel

• Child must use age-appropriate car seat or seatbelt
• The collar should remain on during travel
• Ensure car seat headrest does not push the head forward
• Take breaks on long trips to check skin and comfort
• Bring cleaning supplies and spare collar pads
• Carry medical documentation and healthcare provider contact information

Air Travel

• Notify airline in advance about the medical device
• Carry medical documentation and prescription
• Pack spare collar and pads in carry-on luggage
• Bring cleaning supplies for hygiene during travel
• Request assistance if needed for boarding and seating

Travel Preparation Checklist

• Two sets of clean collar pads
• Cleaning supplies for both collar and skin
• List of medications and medical information
• Healthcare provider's contact information
• Hospital or clinic information at destination
• Insurance information and cards

Emotional and Psychological Support

Wearing a cervical collar can be challenging for children emotionally as well as physically. They may feel self-conscious, frustrated, or upset about the restrictions.

Supporting Your Child

• Explain in Age-Appropriate Terms: Help them understand why the collar is necessary and that it is temporary
• Maintain Normal Routines: Keep daily schedules as consistent as possible
• Encourage Expression: Let them talk about their feelings and frustrations
• Personalize the Collar: Allow them to decorate it with stickers or favorite colors
• Stay Connected with Friends: Facilitate continued social interaction through video calls or supervised visits
• Provide Distractions: Engage them in activities they can do safely
• Celebrate Progress: Acknowledge their cooperation and mark healing milestones
• Be Patient: Recovery takes time and adjustment

School and Social Life

Communicate with teachers and school staff about:

• The child's medical condition and restrictions
• Physical education and recess limitations
• Possible need for extra time or assistance
• How to handle questions from classmates
• Emergency contact information

Help your child prepare for questions from friends by practicing simple explanations they feel comfortable giving.

Resources for Further Information

Recommended Medical References

For healthcare professionals and caregivers seeking detailed information:

• American Academy of Pediatrics (AAP) official website and publications on pediatric trauma
• Journal of Pediatric Orthopaedics - research articles on cervical spine management
• Emergency Medical Services for Children (EMSC) resources
• Orthopedic and spine specialty organizations guidelines

Medical Textbooks

• Nelson Textbook of Pediatrics - comprehensive pediatric medical reference
• Tachdjian's Pediatric Orthopaedics - detailed orthopedic information
• Green's Skeletal Trauma in Children - specific to pediatric bone and spine injuries

Online Educational Resources

• National Institute of Health (NIH) information resources
• Children's hospitals websites with parent education sections
• Pediatric orthopedic society educational materials
• Medical device manufacturer instructions and educational videos

Key Takeaway Points

• Cervical collars are medical devices that must be prescribed and fitted by healthcare professionals
• Never apply a collar yourself in an emergency situation - call emergency services
• Proper sizing and fitting are essential for both safety and effectiveness
• Regular skin checks and hygiene prevent complications
• Follow the prescribed wearing schedule exactly
• Two people are required to safely apply or remove a rigid collar
• Watch for warning signs that require immediate medical attention
• Keep all follow-up appointments to monitor healing
• Maintain open communication with your healthcare team