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Background. Excessive cervical flexion-extension and mild to severe impact injuries can lead to C2 synchondrosal fractures in young children. Objective. To characterize and classify C2 synchondrosal fracture patterns. Materials and Methods. We retrospectively reviewed imaging and medical records of children who were treated for cervical spine fractures at our institution between 1995 and 2014. We reviewed all fractures involving the five central C2 synchondroses with regard to patient demographics, mechanism of injury, fracture pattern, associated fractures, other injuries, treatment plans and outcome. Results. Fourteen children had fractures involving the central C2 synchondroses. There were nine boys and five girls, all younger than six years old. We found four distinct fracture patterns. Eleven complete fractures were further divided into four subtypes (a, b, c and d) based on degree of anterior displacement of the odontoid segment and presence of distraction. Nine of these 11 children had fractures through both odontoneural synchondroses and the odontocentral synchondrosis; one had fractures involving both neurocentral synchondroses and the odontoneural synchondrosis; one patient had fractures through bilateral odontoneural and neurocentral synchondroses. Three children had incomplete fractures defined as a fracture through a single odontoneural synchondrosis with or without partial extension into either the odontocentral or the adjacent neurocentral synchondrosis. All complete fractures were displaced or angulated. Four had associated spinal cord injury, including two contusions (subtype c fractures) and two fatal transections (subtype d fractures). Most of the 11 surviving patients were treated with primary halo stabilization. Subtype c fractures required surgical fixation. Conclusions. We describe four patterns of central C2 synchondrosal fractures, including two patterns not previously reported. We propose a classification system to distinguish these fractures and aid in treatment planning.