A uniformly accepted protocol for evaluation and clearance of the cervical spine of pediatric trauma patients with altered mental status does not currently exist. We sought to detect cervical spine injuries in this group with minimal risk. Patients were evaluated with standard three-view cervical spine radiographs and CT when necessary. Those patients without radiographic abnormality and altered mental status underwent flexion-extension of the cervical spine using fluoroscopy with somatosensory evoked potential (SSEP) monitoring. Those with abnormal movement by fluoroscopy or changes in SSEP underwent MRI. Fifteen patients were evaluated with this protocol. Two patients had movement on flexion-extension of the cervical spine and 5 had SSEP changes. Three patients had an MRI with only 1 showing injury. Five patients had residual hemiparesis. Evaluation of the cervical spine in obtunded or comatose pediatric trauma patients can be done safely with flexion-extension under fluoroscopy and SSEP monitoring. Further prospective studies are required to determine the efficacy of SSEP monitoring for cervical spine clearance in this select population.