In most cases of traumatic cervical spine injuries in children, nonoperative treatment, mainly external stabilization, is sufficient. When operative treatment is chosen, surgeons often recommend posterior stabilization. In a subset of pediatric patients, the anterior approach is indicated. The anterior operative approach was employed in six children three to 14 years of age who sustained trauma to the cervical spine. The injuries included severe hyperflexion injury with crush fracture and avulsion of the vertebral body, fracture-dislocation of the vertebral body with involvement of the posterior elements and the disk, and injuries that caused major anatomic deformity of the cervical spine with cord compression. Anterior decompression with bony fusion led to normal anatomic alignment with neurologic improvement in all patients. Follow-up evaluation as long as eight years showed solid fusion and remodeling of the bone grafts. The anterior approach should be used more frequently as the surgical procedure of choice in children with traumatic lesions of the cervical spine. The anterior approach provided direct visualization of the lesion, which enabled effective repair and stabilization, early ambulation with minimal morbidity, and significant long-term neurologic improvement.