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Objective: To study the frequency and clinical implications of environmentally responsive temperature instability in hospitalized pediatric patients with spinal cord injury (SCI). Setting: A tertiary level SCI rehabilitation unit located in a free standing children's hospital in Wilmington, DE, USA. Study Design: Temperature data and corresponding clinical responses were collected prospectively between January 1991 and June 1993. Fifty-four consecutive patients with SCI levels at or above T6 were admitted to the pediatric spinal cord injury rehabilitation unit over that time (4059 SCI days). Methods: Hypothermic events were de®ned as oral temperatures less than 35.08C or rectal temperatures less than 35.68C. Hyperthermic events were de®ned as oral temperatures greater than 38.08C or rectal temperatures greater than 38.48C. The events and the clinical responses were reviewed retrospectively and were used for subsequent analysis if there was evidence of clinical response to environmental manipulation within 4 hours of case identi®cation, and other potential etiologies of temperature¯uctuation could be excluded. Results: Sixty-®ve events of hypothermia (1.60%) and 14 events of hyperthermia (0.34%) were analyzed. Twelve patients (22%) accounted for all 79 events. Subjects with environmentally responsive temperature instability were more recently injured (P50.001), had longer lengths of stay (P50.001) and were more likely to be ventilator dependent (P50.002) than those who did not have environmentally responsive temperature instability. There was no signi®cant di erence between the two groups in age, gender, level or etiology of the SCI. There were no adverse clinical outcomes as a result of the environmentally responsive temperature instability. Conclusions: Environmentally responsive temperature instability a ects a select subset of pediatric aged spinal cord injured persons. Early recognition of the potential contribution of the environment to temperature¯uctuation in this group has led to the successful utilization of a temperature instability protocol on our SCI unit.