Pediatric spinal emergencies differ significantly from those in adults due to the unique characteristics of the developing spinal column. In children, the spinal column is more mobile and deformable, which leads to different absorption and distribution of traumatic forces compared to the adult spine. Additionally, each pediatric age group exhibits distinct patterns of injury. Understanding the normal anatomy of the developing spine is crucial for accurate diagnosis of traumatic injuries. Nontraumatic spinal cord emergencies in children have various causes, including spinal cord tumors such as astrocytomas and ependymomas, as well as inflammatory and autoimmune conditions such as multiple sclerosis and neuromyelitis optica spectrum disorder. Cord infarction, although rare, can occur in childhood. For suspected spinal injuries, CT is often the first-line imaging modality, depending on the type of injury. MRI is better suited for assessing spinal cord injuries and potential ligamentous disruptions. MRI is the preferred modality for investigating nontraumatic spinal emergencies. This chapter provides a comprehensive summary of the epidemiology, clinical signs and symptoms, diagnostic imaging work-up and imaging features of both traumatic and nontraumatic pediatric spinal emergencies, and normal anatomical variations.