Pediatric spinal injuries, though infrequent, pose a significant risk of morbidity and long-term disability. The unique anatomical and biomechanical characteristics of children—including increased ligamentous laxity, incomplete ossification, and a larger head-to-body ratio—contribute to distinct injury patterns and presentations when compared to adults. Mechanisms such as falls, road traffic accidents, sports injuries, and non-accidental trauma are common contributors. Among younger children, spinal cord injury without radiographic abnormality (SCIWORA) remains a critical diagnostic challenge. Timely recognition and intervention are essential to mitigate complications and optimize neurological recovery. However, due to the subtlety of early signs, especially in non-verbal or uncooperative children, the diagnosis may be delayed without a high index of suspicion. A structured approach using repeated primary and secondary surveys, strict cervical spine immobilization, and detailed neurological assessment is crucial in the early stages of management. In district hospitals, rural health centers, and other resource-limited settings, Primary Care Providers (PCPs) are often the first responders. Their role is pivotal in the initial triage, stabilization, and coordination of care. This includes ensuring spinal precautions, recognizing signs of spinal trauma, administering supportive care, and initiating safe referral pathways. PCPs also serve as key communicators with families, providing emotional support, education, and advocacy during critical moments of uncertainty. Effective management of pediatric spinal trauma demands collaboration across specialties, from emergency care and radiology to neurosurgery and rehabilitation. Incorporating family-centered care principles—by involving caregivers in decision-making and addressing psychosocial needs—can enhance both immediate and long-term outcomes. This chapter provides a comprehensive overview of the recognition, initial management, and referral considerations for spinal trauma in children, with a practical focus on empowering PCPs to act decisively and compassionately in the face of high-stakes clinical scenarios.