Complications and problems in halo treatment of toddlers: limited ambulation is recommended.

Although halo fixation in children aged 3 years or younger is described, no study has reported results in this age group. A retrospective review was conducted among children aged 3 years and younger and treated with halo ring fixation. Thirteen patients were identified, with an average age of 26 months (range, 16-43 months) at halo application. Six patients were treated for trauma, 6 for stabilization after cervical arthrodesis, and 1 for traction for progressive infantile scoliosis. All the children required custom or modified rings and vests. On average, 8 pins (range, 6-12) were used for fixation with torque from 2 to 4 in-lbs. Nine (69%) of the 13 patients had complications including 6 pin infections, 3 falls, and 1 respiratory difficulty. Only 1 child required further surgery. None developed posttreatment skull deformity. Halo ring fixation is safe in children aged 3 years and younger and has a complication rate similar to that in older children. Pin problems can be treated effectively by standard means. Unique to this age group, toddlers may be more prone to falls than older children, and limited ambulation should be recommended.