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When Your Child Was in the Car: Injuries Parents Should Know About

A parent guide from Dr. Verg Chiropractic, serving Vancouver, WA and Clackamas, OR

After a car accident, most parents check their children first. If nobody is crying and there are no bruises, everyone breathes a sigh of relief. But in our office we see the same thing again and again: the child who “wasn’t hurt” shows up a day or a week later with a stiff neck, a sore back, a shoulder that hurts when they lift their backpack, changes in behaviour, or a toddler who suddenly won’t sleep.

Children’s bodies are not small adult bodies. Their necks are built differently, they move differently in a crash, and they show pain differently. That is why at Dr. Verg Chiropractic we examine every child who was in the car, even the one who says they feel fine.

This guide covers the neck, back, shoulder and other body injuries we see in children after crashes. If you are worried about a head injury, read our separate guide, Children’s Concussion After a Car Accident.

Why a child’s neck is injured differently

For a long time, people assumed children were mostly spared from whiplash. Early German research (1988) estimated a child’s risk at one-sixth of an adult’s. Later Swedish research (1995) found it is much closer: about two-thirds of an adult’s risk (Croft, 2000).

A child’s anatomy explains why (Croft, Whiplash Injuries):

The head is large and heavy for the size of the neck.
The bones are not fully hardened yet, in the skull or the spine.
The small joints of the neck are flatter, so the vertebrae slide on each other more easily.
The ligaments are naturally looser.

The youngest children are most vulnerable at the very top of the neck, where the skull meets the spine. In a large study of 540 children with neck (cervical spine) injuries at 17 children’s hospitals, car crashes were the leading cause in young children: 56% of neck injuries under age 2 and 37% at ages 2 to 7. In children under 8, about three out of four of these injuries were in the upper neck, between the base of the skull and the second vertebra (74% under age 2, 78% at ages 2 to 7) (Leonard et al., 2011). Young children are also about 2.5 times more vulnerable than adults to the skull separating from the top of the spine, because the joints there are small and lie flatter, which makes the area less stable when a car stops suddenly or an airbag goes off (11).

This matches what we find on exam. In our charts, the very top joint of the neck (C1) was restricted in almost every child we examined after a crash, from toddlers to teens.

The serious injuries in that hospital study are rare, and they are hospital emergencies, not chiropractic cases. The point for parents is that the upper neck takes the most strain in a young child, so it deserves a careful look even after a crash that seemed minor.

Pain often shows up the next day, or the next week

Nearly half of children seen in emergency rooms after car crashes develop whiplash. In a study of children ages 4 to 16, 47% had whiplash-associated disorders. Symptoms started within 24 hours in 60% of them, and within 48 hours in the rest. Mild (grade 1) whiplash cleared in about a week on average (6.4 to 8.8 days), but grade 2 injuries, with measurable stiffness and tenderness, lasted significantly longer (Boyd et al., 2000, 2002).

We see delays like this in our own charts all the time:

A 5-year-old in a forward-facing car seat was startled but did not cry after a slow parking-lot bump. The next day she complained of neck and arm pain “which she had never complained about before,” and cried through a sleepless night.
A 13-year-old who hit his left knee on the dashboard was fine on that side. It was his right knee that started hurting after he got out of the car, and it got worse during his first class at school.
A 9-year-old had a headache the next day, then neck, back and knee pain the following week.
An 8-year-old and a 10-year-old both developed significant neck and back pain about a week after their crashes.
A 6-year-old had no complaints for about two months. When she became more active again, neck and shoulder pain appeared.

A note for parents: don’t judge by how your child looks at the scene. Adrenaline and excitement hide pain. Watch them for the next several days, and have them checked even if they say they are fine, but better yet let’s watch them together.

Children show pain differently

Every child’s chart in our office carries the same reminder: “Children have altered perception and expression of pain and therefore specific symptomatic details are difficult to ascertain” (Mathews, 2011). So we do not rely on a child telling us where it hurts. We rely on what we can measure and feel, and on what the parents see at home.

In our charts, these are the changes parents noticed after a crash:

Sleep: an 18-month-old who used to wake once a night started waking two or three times. A 2-year-old refused to sleep in her crib. A 5-year-old woke three or four times a night. A 9-year-old began sleep-talking and sleepwalking.
Mood: “more irritable than prior to the crash” (a 4-year-old); “less emotionally stable” (a 5-year-old); crying, laughing and shouting that one family called a “rollercoaster” (an 8-year-old).
Gestures instead of words: the 18-month-old would touch his neck, asking his mom to rub it. A 2-year-old complained of neck pain only when getting dressed.
Posture and appetite: a 5-year-old started keeping her head down while playing, and her appetite dropped “despite previously eating a lot.”
Play and sports: children who stopped soccer, ballet, gymnastics or biking, and a 9-year-old who stayed in bed instead of playing.
Fear: a 7-year-old with fear and trouble sleeping, another child with nightmares about crashes, and teens afraid to ride in a car.

Fear after a crash is common and real. Six weeks after a road crash, 69% of children who had no brain injury still had significant post-traumatic stress symptoms (Mather et al., 2003). In our charts, one teen’s fear of riding in a car resolved by the end of care. Another teen still felt stress on the road at discharge, which is worth knowing as a parent and sending them to a concussion specialist.

When a child’s sleep, mood, appetite and play return to normal, we count that as recovery, right alongside a normal exam.

Not just the neck: shoulders, backs and knees

Whiplash is usually thought of as a neck injury. In children, our charts show it is almost always more than that.

The whole spine together. Neck, mid-back and low-back sprains were often diagnosed together. Mid- and low-back pain was often as strong as the neck pain.
Shoulders. A shoulder (rotator cuff) sprain or strain was diagnosed in 46 of 50 crash cases in children ages 6 to 17. The seatbelt crosses the shoulder, and children brace with their arms. One teen grabbed her unbelted sister to keep her from “flying into the windshield” and injured her own shoulder doing it. Shoulder injuries show up as pain lifting a backpack, carrying groceries, holding a baby sibling, or doing a back bend in gymnastics.
Knees. Children in the front seat hit the dashboard, and children in the back hit the seat in front of them. Knee sprains, kneecap tendon irritation and, in one teen, a small meniscus tear found on MRI all came from crashes.
Chest and jaw. Seatbelt pain across the chest, and jaw (TMJ) strain, appeared in several children, including a 2-year-old. A child or adult does not need to strike the face to injure the jaw.

This is why our exam covers far more than the neck.

How we examine a child after a crash

A child can move normally, pass every movement test, and still be injured. Many of the children in our charts had full range of motion but clear tenderness, muscle spasm and stuck joints when examined by hand. Two siblings came in months after their crash with no pain complaints at all, yet both had joint restrictions and spasm. So our exam is thorough, and most children treat it like a game.

The crash story. Where the child sat, what kind of seat or belt they used, which direction the impact came from, and whether their head was turned or they were leaning, sleeping or looking down at a phone. These details tell us where to look.
The upper neck. We feel and gently test the joints where the skull meets the top two vertebrae, the area most at risk in young children.
Measured movement. Neck and low-back range of motion is measured in degrees and compared with normal values for children. We use a large joint goniometer for objective measurement, and left to right differences show up often.
Hands-on palpation of every segment. As Dr. Verg explains to patients, he is feeling tension, spacing and swelling, a skill he compares to a pianist’s muscle memory.
Shoulders, hips, knees and jaw. Rotation, strength and tenderness, because so many children injure these too.
Posture and growth. Leg length, the forward-bend test for spinal curves, and a scoliometer. When a curve is found, we note whether it came from the crash or was already there. One 17-year-old’s curve measured the same before and after care, so it predated the crash. Dr. Verg tells parents of children with a tendency toward a curve to keep watching the spine through growth spurts.
Nerves, balance and grip (crucial part of the examination). Reflexes, sensation, grip strength, balance with eyes closed, visual reflexes, eye movements and age-appropriate nerve and development checks.

This matches published guidance for examining children after major trauma: a detailed crash history, upper-neck palpation and motion testing, neck range of motion, and age-appropriate nerve and development checks.

X-rays and other imaging. Consensus guidelines for chiropractic care of children list a history of trauma, such as a car crash, as a main reason to take X-rays (Hawk et al., 2009). A child’s spine has normal developmental features that can look like an injury on film, so reading pediatric X-rays takes care to tell normal growth from a true injury. When we find something that needs more than chiropractic care, we refer: in our charts, an 8-year-old with a weak, painful shoulder was sent for an MRI and to an orthopedist, and a teen with a locking knee was referred to orthopedics after an MRI. Imaging can help, but it does not tell the full story.

What we never do after a head injury. Some pediatric techniques test a baby by holding them upside down by the legs. A recent head injury or bleeding makes this test absolutely off-limits, and we do not use it after a crash.

How we treat children, by age

Children need far less force than adults, and care is matched to the child’s age and how sore they are.

Age	How we adjust	Other care
Babies and toddlers	Light pressure adjustments made for infants and children, with no thrust; gentle cranial (skull bone) work	Short massage (as little as 15 minutes for an 18-month-old)
Preschool and early school age	No-thrust joint mobilization at first, then a low-force, pain-free adjustment with the child lying in a neutral position	30 to 45 minute massage, simple exercises
Older children and teens	Gentle Diversified adjustments to the spine, plus the shoulders, knees or wrists when injured	60 minute massage, trigger point work, gentle traction or muscle stimulation when needed

Home exercise. Children get simple, age-appropriate exercises: resistance bands, lifting the head and chest while lying face down, planks on the knees, push-up-plus for the shoulder blades, corner stretches, bridges, and curve-specific exercises for children with scoliosis.

A planned return to sports. Care continues while the child tries harder activities again, and we recheck that the improvement holds as the load increases. Several children in our practice had a trial period of more activity, or a month off care, before final release. When a child is ready, we release them to PE and sports in writing.

A typical course of care. Usually twice a week for four to five weeks, then a re-exam, then weekly visits as the child improves. Most children in our charts needed about 9 to 17 visits over two to five months. When visits are hard to fit around school, we can write a letter asking the school to allow appointments during school hours.

Recovery stories from our office

Details have been changed or left out to protect patient privacy. Results vary from child to child.

Touching his neck: 18-month-old boy, side impact

What we saw: the family minivan was hit on the driver’s side while stopped at a light. He could not say what hurt, but he kept touching his neck, asking his mom to rub it, and he went from waking once a night to two or three times. On exam the left side of his spine was tender and tight from neck to low back, and his skull bones and several spinal joints were restricted.
Treatment: light pressure adjustments made for infants, with no thrust, gentle cranial work and a short massage. About 7 visits over 11 weeks.
Improvement: his parents reported 100% improvement. The night waking, fussiness and neck discomfort were gone, and the tenderness and skull restrictions had resolved.

Fine at the scene, hurting the next day: 5-year-old girl in a forward-facing car seat

What we saw: a slow parking-lot “bump”. She was scared but did not cry. The next day she had neck and arm pain and a sleepless, tearful night, and her parents found her “less emotionally stable.” Weeks later her mom noticed swelling in her neck and shoulder, a new habit of keeping her head down while playing, and a drop in appetite.
Treatment: gentle spinal mobilization, shoulder adjustments, massage and exercises, twice a week and then weekly. About 15 visits over 5 months.
Improvement: 100%. The swelling, neck and shoulder pain and appetite drop all resolved, and she returned to normal activities without restrictions.

Won’t sleep in her crib: sisters aged 2 and 4, rear-ended while stopped

What we saw: the 2-year-old was dazed after the crash and then refused to sleep in her crib. Her 4-year-old sister had neck pain, poor sleep and more irritability. Both had tender, restricted joints from neck to low back and sore shoulders.
Treatment: low-force, pain-free adjustments in a neutral position, shoulder mobilization, massage and simple exercises. About 9 visits each over 14 weeks.
Improvement: both reached 100% with perfect sleep, mood and no pain.

Afraid and off the soccer field: 7-year-old boy, frontal crash

What we saw: his mom swerved to avoid a car pulling out, and both cars were towed. He had his head turned at impact. Afterward he had neck and back pain, fear and trouble sleeping, and had not tried soccer. On exam one leg measured 7 mm shorter and there was a 10-degree curve in his mid back.
Treatment: no-thrust mobilization at first, then gentle adjustments and cranial work, massage, and a home resistance-band program. Dr. Verg also talked with him about wearing a helmet on his electric bike.
Improvement: at his re-exam his back pain was gone and his headaches had stopped. By his final exam, about 3 months after the crash, he was 100% better: full PE and recess, plus running, basketball, football, soccer and volleyball. The curve and the leg-length difference were no longer present.

Stayed in bed: 9-year-old girl, rear-ended in highway traffic

What we saw: a headache the next day, then neck, back and knee pain the following week. She had been very active with biking and ballet, but now she stayed in bed, her backpack hurt, and she was sleep-talking and sleepwalking. X-rays showed a mild curve in her low back.
Treatment: gentle adjustments, massage and muscle stimulation. About 11 visits over 9 weeks.
Improvement: 100%, with every diagnosis resolved.

A young gymnast’s shoulder: 8-year-old girl, frontal crash

What we saw: right shoulder and neck pain right away. Her shoulder muscles tested weak and painful (4 out of 5), and she was hesitant to start gymnastics.
Treatment: gentle adjustments, shoulder mobilization, massage and shoulder stretches, plus a shoulder MRI and orthopedic referral to make sure nothing more serious was going on.
Improvement: 80% at 3 months, when a back bend still hurt. At her final exam she was 100%, with full shoulder motion.

The other knee: 13-year-old boy, front passenger

What we saw: his left knee hit the dashboard and bruised, but it was his right knee that began hurting after he got out of the car. He also had shoulder and spinal findings he barely noticed.
Treatment: gentle adjustments to the spine, pelvis and shoulders, massage, and coaching to hold off on high-impact sports for a while. About 8 visits over 14 weeks.
Improvement: his knee pain stopped and he went back to basketball and volleyball, including diving for the ball. Final exam: 100%, every finding resolved.

A rollover: 15-year-old boy

What we saw: the car rolled into a ditch and landed on its side. He had constant mid- and low-back pain and could bend forward only 21 degrees (normal is about 60). His left shoulder was weak.
Treatment: gentle adjustments, traction, core exercises (planks and bridges) and massage. About 13 visits over 9 weeks.
Improvement: 100%. He could bend forward 65 degrees, his neck turned normally, and his shoulder strength was back to normal.

Low speed, real injury: 12-year-old gymnast

What we saw: her dad backed hard into another car. It seemed minor, but practice the next day was hard, and her exam showed signs of irritated nerves running from the neck into the arm.
Treatment: mobilization and gentle adjustments, muscle stimulation, massage and exercises. About 14 visits over 5 months.
Improvement: 100%, with an “excellent” outlook. She returned to full gymnastics, including round-offs, unspotted back tucks, beam and vault.

What our records show

We reviewed the completed charts of 58 children treated in our office after car accidents. Of the 52 courses of care that reached a final exam, 45 ended at 100% improvement for the neck, back, shoulder and other body injuries.

Age group	Children	Typical care	Result at final exam
18 months to 5 years	10	7 to 16 visits over 1 to 5 months	All 10 at 100%
6 to 11 years	22	6 to 27 visits (usually 11 to 13) over 6 weeks to 5 months	15 of 18 at 100%; the rest 75% to 95%
12 to 17 years	26 (28 crashes)	9 to 23 visits over 2 to 5 months	20 of 24 at 100%; the rest 75% to 95%

When a child did not reach 100%, the most common reasons were head-injury symptoms that needed a specialist, a knee or wrist that needed an orthopedic opinion, or a family that could not finish the recommended visits. Most children were discharged with only minor, painless joint stiffness, and told to come back as needed.

What published chiropractic case reports describe

Beyond our own office, chiropractors have published single-patient reports of children whose nervous system symptoms improved after upper neck care following a crash. These are individual cases, not controlled studies, but they show why the upper neck deserves attention:

Weakness on one side of the body. A 7-year-old boy hit by a car developed weakness on one side. X-rays and CT showed no fracture, and the hospital called it a “torqued brain stem.” The weakness completely resolved after upper neck adjustments (Schimp & Schimp, 1992).
Paralysis on one side and brainwave changes. A child left unable to move one side after a car collision had abnormal computer-analyzed brainwave (EEG) readings. After upper neck adjustments, the readings normalized and the child regained control of the left arm and leg (Hospers, 1992).
Behavior change after a crash. A 7-year-old boy developed dramatic behavior changes, agitation, memory problems, neck and ear pain, trouble breathing through his nose, and pain in both legs. X-rays showed the second neck vertebra slipped forward on the third and a reversed neck curve. After a series of adjustments, his attention problems and physical symptoms fully resolved (Arme, 1993).

Seats, belts and boosters

Two teen sisters were in two crashes a year apart. In the second, one sister was unbelted, and the other injured her own shoulder grabbing her to stop her flying forward.
Children wearing a lap belt with no shoulder strap, children in backless boosters, and an 8-year-old riding in the front seat of a pickup were all among our patients.
Children who were asleep against the door, leaning on an elbow, or looking down at a phone at impact often had one-sided injuries.

What parents can do: buckle every child on every trip, use the car seat or booster that fits your child’s age and size, keep children in the back seat, and make sure the shoulder belt crosses the shoulder, not the neck. Always use a booster that includes a seat back. After any crash, have every child who was in the car checked.

What parents can take from this

Children often look fine and say they feel fine. Pain can appear a day, a week, or even months later.
Trust what you notice: sleep, mood, appetite, posture and play are how young children tell you something hurts.
Shoulders, backs and knees are injured almost as often as necks.
With gentle care matched to their age, most children in our records recovered fully in two to five months.
Get every child who was in the car checked, even the one who “wasn’t hurt.”

Gentle care for the whole family in Vancouver, WA & Clackamas, OR

If your child was in a car accident, have them checked, even if they say they feel fine. At Dr. Verg Chiropractic we examine every family member who was in the car.

Complimentary new-patient consultation for each family member after a car accident.
Direct insurance claim handling: we work directly with auto insurance Personal Injury Protection (PIP) claims, so you can focus on your family.
Multilingual care team: English, Ukrainian (Українська), and Russian (Русский).
Vancouver, WA clinic: 109 SE 101st Ave, Vancouver, WA 98664. Phone: (360) 203-6000
Portland / Clackamas, OR clinic: 10001 SE Sunnyside Rd #120, Clackamas, OR 97015. Phone: (503) 386-9819

Worried about a head injury? It is much more common than you think. Read our guide, Children’s Concussion After a Car Accident.

Medical disclaimer

This article is provided for educational and informational purposes only and does not constitute formal medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider regarding your child’s condition or post-accident symptoms.

When to call us right away, or go to the ER: if your child has vomiting, severe difficulty being awakened, loss of consciousness, slurred speech, failure to recognize people or places, or increasing confusion, call our office immediately, or go to the emergency department if the doctor is unavailable.

References

Arme JJ. Journal of Chiropractic Case Reports. 1993.
Boyd R, et al. 2000, 2002.
Croft AC. Whiplash Injuries. 3rd ed.
Croft AC. Dynamic Chiropractic. 2000.
Hawk C, et al. Journal of Manipulative and Physiological Therapeutics. 2009.
Hospers LA. Proceedings of the National Conference on Chiropractic and Pediatrics. 1992.
Leonard JR, et al. PECARN cervical spine injury study. Journal of Pediatrics. 2011.
Mathews L. Pain in children: neglected, unaddressed and mismanaged. Indian Journal of Palliative Care. 2011;17(Suppl):S70-S73.
Mather FJ, Tate RL, Hannan TJ. Brain Injury. 2003.
Schimp J, Schimp D. Chiropractic Technique. 1992.
Gilles FH, Bina M, Sotrel A. Infantile atlantooccipital instability: The potential danger of extreme extension. Am J Dis Child. 1979;133(1):30–37

Children and Car Accidents: A Parent Guide