Purpose C1 pedicle screw technique showed further advantages since it avoids the negative results from the sacrificed range of motion of the atlantooccipital joint compared to the occipitocervical fusion. However, some intractable complications are unavoidable. In the pediatric population, dysphagia after the atlantoaxial fixation can be accidentally serious. We aimed to determine the incidence of dysphagia in the pediatric population's cohort and its radiological predictor. Methods Between January 2010 and August 2018, this retrospective study included 42 pediatric patients with atlantoaxial dislocation due to trauma. They were followed up with an average duration of 8 years (range 5-18 years). Twenty-seven were males and 15 females with a mean age of 8.2 years (range 5-15 years) when undergoing operations. Patients were classified according to the presence of postoperative dysphagia according to the Bazaz dysphagia grading scale. The measurements, including pre- and postoperative CVT/NSL, O-C2, and C2-C7 sagittal angles, were performed. Results 26.2% of the patients (11/42) experienced postoperative dysphagia. A significant difference in the postoperative CVT/NSL (115.2 +/- 13.2 vs.134.8 +/- 17.3, P = 0.002), Delta CVT/NSL (7.0 +/- 11.2 vs. 20.3 +/- 10.5, P = 0.001), Delta O-C2 (- 3.2 +/- 5.8 vs. 2.1 +/- 5.1, P = 0.026), postoperative nPAS (9.4 +/- 3.7 vs. 12.6 +/- 4.2, P = 0.031) and Delta PAS (- 1.5 +/- 4.1 vs. 2.0 +/- 3.5, P = 0.010) between dysphagia group and non-dysphagia group were found. Adjustment for age, gender, and BMI, the multivariate logistic analysis showed that Delta CVT/NSL < 8.35 degrees (OR = 5.23; 95% CI 4.97-5.50; P = 0.001) and Delta O-C2 (OR = 3.34; 95% CI 3.17-3.51; P = 0.001) remained associated with the occurrence of the swallowing problems. Conclusion In comparison with Delta O-C2, Delta CVT/NSL might better predict postoperative dysphagia in children.