Twelve cases of Chance-type flexion-distraction injuries in children less than 16 years old were reviewed. Patients were evaluated in terms of initial treatment regimen, subsequent modifications, and ultimate outcome. Follow-up ranged from 6 months to 9 years. Seven patients with a significant ligamentous component to their injury were initially treated, for various reasons, in a brace. All patients responding to brace treatment had an initial kyphotic deformity of less than 20 degrees and a maximum measured deformity of less than 25 degrees. In patients in whom brace treatment failed, initial deformity was greater than 20 degrees in all cases. Kyphotic deformity progressed to greater than 30 degrees before surgical intervention in these four cases. Improved adherence to lap seatbelt precautions, while of great benefit in reducing motor vehicle-related morbidity and mortality, has simultaneously increased the likelihood of flexion-distraction lumbar spine injuries. Our results suggest that an approach to treatment designed specifically for children is appropriate.