Head injuries in children are common. With the amount of energy they have, most children are constantly on the move, running and playing. But all activities have a risk of falls and injuries, and a bang to the head if severe can be the most devastating.
Severe head injuries are uncommon in children but do you know what to do if a head injury does occur?
Falls are the commonest cause of head injury in children and adolescents. This is followed by sports injuries, vehicle accidents, bicycle accidents and lastly child abuse.
There are several reasons why children are more prone to head injuries, being more energetic and less coordinated.
In younger children, having a disproportionately larger and heavier head and weak neck muscles renders them prone to head injury after trauma. The risk of brain injury which can have long term consequences depends on the severity of the injury.
The type of injury can be classified according to the severity. Low force injuries such as being hit with a ball or a short fall have a low risk of brain injury.
Those injuries which are high impact such as being in a vehicle accident, falls from a significant height, penetrating trauma to the head and inflicted injury have the potential to cause significant injury. These types of injuries can have significant impact on the child or adolescent’s long term health by causing a mental or physical disability.
The type of head injury will determine the signs and symptoms a child may have after a head injury:
- Swelling: A bump on the scalp occurs because the scalp has many blood vessels and if there isn’t a cut in the skin, blood accumulates under it. This doesn’t mean that the child necessarily has a bleed in the brain
- Concussion: used to describe a mild form of head injury. This includes having a period where the child is dazed and cannot remember events etc. May also be associated with vomiting and headaches
- Headaches: Very common, occurs in about 20% of children with head injuries. If they are very young children this may manifest as being irritable
- Loss of consciousness: happens in about 1 % of children and lasts normally less than one minute in low impact head injuries
- Vomiting: Though common, this doesn’t necessarily mean that there is a significant head injury
- Fits : less than 1 % have a fit but if they do, it is necessary to rule out a severe brain injury
What to do?
It’s difficult, if not impossible to keep an eye on children all the time. But if a child or adolescent has a head injury, find out what exactly happened. This is useful information to give the medical professional if your child needs to be assessed. Most minor head injuries don’t need to be seen by a doctor but knowing what signs to look out for is very important.
Children with the following symptoms should be assessed by a doctor
- Recurrent vomiting
- Headaches which are worsening in intensity
- Loss of consciousness
- Seizures
- Weakness-stumbling
- Slurred speech
- Disorientation and drowsiness which persists
- Clear fluid leaking from nose or ear
- If the child fell from a height – more than 5 feet, or was hit by a high speed object or hit with great force
- If the child is less than six months old
- If the parent or the carer is concerned about the child’s behaviour
Doctors will assess how serious the head injury is, first by taking a thorough history and examining the child. Then the child may or may not, depending on the findings, undergo a CT scan. They may also request an x-ray of the neck to rule out any injury to the bones in the neck. Depending on the findings the child will be managed accordingly.
The CT scan will be carried out to look for any blood in the cranial cavity or the brain. This will also show any fractures of the skull. The management of the child will depend on the findings. If a minor head injury is diagnosed the child will be sent home with advice. A moderate head injury not requiring any surgery can be managed by admitting the child for a few days and observation; if it is a serious head injury a neurosurgeon will be contacted.
If the child has a minor head injury, he or she can be managed at home with close observation by the parent. But keep a close watch for the aforementioned worrying signs.
What to do at home?
- Encourage the child to rest in a quiet place- but keep an eye on the child
- If there is a swelling an ice pack can be helpful- the child should normally settle down after a couple of hours
- I f there is a cut to the head, put pressure then wash and clean with soap and water and keep clean; if bleeding is significant seek medical attention
- Simple analgesics which do not cause drowsiness can be used for pain relief
- When the child is sleeping you should arrange to observe him/her at 2 hour intervals to establish
- If he/she is breathing normally
- Is the sleeping posture normal
- Is he/she making the expected response when you rouse them
Long term effects
Minor falls and head injuries are part of growing up, and they will occur however careful you are. Avoiding major head injury is the main priority as permanent damage in the form of psychological, emotional and physical can occur which has a profound effect on their future.
All head injuries can cause problems in concentration and memory depending on the extent of the injury. If minor the child should recover completely and reassurance and encouragement is essential. With moderate to severe psychological effects, neuropsychological input early on can be very helpful. Injuries causing physical problems should also be dealt with early with appropriate physiotherapy and occupational therapy. This is a topic in itself which will be dealt with separately.
(The writer is a Consultant Neurosurgeon) |
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