Head injuries in children

Head injuries in children

Head injuries are a common reason for parents and caregivers to take children to a hospital emergency department. Most head injuries are not severe; however, occasionally they may be life-threatening and/or result in long-term complications. For this reason, it is important that head injuries in children are assessed by a doctor.

In general, children are at increased risk of more serious head injuries than adults because they:

• Have thinner skull bones;
• Have immature brains that are more vulnerable to damage from an injury;
• Have a larger head-to-body-weight ratio, and;
• Are more likely to lose a large amount of blood.

Causes

Head injuries can occur in children of all ages, but they tend to occur more often in boys than in girls. Most are due to:

• Falling from a great height;
• Car accidents;
• Playing contact sports, or;
• Falling off a bicycle or other equipment.

Signs and symptoms

The signs and symptoms of a head injury vary, according to the severity of damage, but can include:

Minor head injuries

• Vomiting no more than once, immediately after the injury;
• Bruises or cuts on the head and/or face;
• No loss of consciousness, and;
• The child is alert and responsive.

Moderate head injuries

• Vomiting twice or more;
• Blurred vision;
• Memory loss;
• Loss of balance;
• Headache;
• A brief seizure, immediately after the injury;
• Large bruises or cuts on the head or face;
• Loss of consciousness for less than 30 seconds, and;
• The child recovers to be alert and responsive.

Severe head injuries

• Persistent vomiting;
• Arm or leg weakness;
• Unequal pupils;
• Neck pain or stiffness;
• Bleeding from the nose or ears;
• Loss of consciousness for more than 30 seconds, and;
• Drowsiness and/or a delayed response when spoken to.

Seek urgent medical attention at your nearest hospital if you suspect a severe head injury.

Concussion

Concussion is when a head injury causes a temporary impairment in brain function. It can commonly occur after a minor or moderate head injury. Typical symptoms include:

• Headache;
• Problems with memory and concentration;
• Loss of balance or coordination;
• Nausea or vomiting;
• Ringing in the ear;
• Blurred vision, and;
• Sensitivity to light.

These symptoms gradually resolve, sometimes over a period of several weeks.

Methods for diagnosis

A head injury is usually diagnosed by taking a medical history from the child or parent/caregiver and performing a physical exam to assess the damage. Most children with a minor head injury do not require any tests, as the risk of significant injury is low. However, a period of observation is common to ensure the child remains well.

Further tests may be conducted in children with a moderate or severe head injury. A computerized tomography (CT) scan is usually the initial test to be performed. Other tests may be ordered if additional injuries are suspected.

Types of treatment

First aid

Following a suspected or observed head injury, it is important to:

• Keep the child calm and still;
• Gently apply pressure to any bleeding cuts;
• If the child is having a seizure or is vomiting, turn them on their side to prevent choking, but try to keep the head and neck in line and straight to protect the spine, and;
• Call an ambulance immediately if the child is unconscious.
• Commence cardiopulmonary resuscitation (CPR) if the child is not breathing.

Promptly seek medical attention after a head injury in children.

Ongoing treatment

Treatment for a head injury is aimed at reducing the chance of permanent brain damage. Seeking urgent medical attention is important, as outcomes improve when treatment starts early.

Assessment and treatment of a head injury is best performed in a hospital. The exact treatment will depend on the types of injuries sustained.

In some cases, a minor head injury can potentially be cared for at home. However, close monitoring is required to ensure the child continues to remain well. Suggested care at home may include:

• Applying an icepack to affected areas, making sure it is wrapped in a towel or washcloth to prevent injuries from direct contact with bare skin;
• Providing pain-relief medication for a headache, such as acetaminophen or ibuprofen;
• Dressing any minor cuts, but seeking medical attention if the bleeding does not stop after 10 minutes, or the cut is large;
• Checking that a sleeping child remains well if the accident happened just before bedtime - if something seems abnormal, promptly seek medical attention, and;
• Preventing further participation in sport for the next 24 hours, particularly if the child was injured during that sporting activity.

Potential complications

Most children with a minor head injury will make a full recovery. If serious injuries occur, potential complications can include:

Post-concussion syndrome

Following a concussion, some children may experience ongoing symptoms for a few months, also known as post-concussion syndrome. Symptoms may include nausea, memory problems, headache, dizziness and poor concentration.

Coma

A coma can occur when the brain is functioning at a reduced level, resulting in a prolonged loss of consciousness. It may only last a few days or weeks, but in some cases may last longer.

Brain damage

Head injuries can lead to permanent brain damage, particularly with severe head injuries. The location and severity of brain damage will depend on the type of head injury, the amount of time that passes before treatment is received and the presence of any other complications.

Brain damage can result in physical and/or intellectual disabilities, which may need ongoing medical treatments, lifelong nursing support, or care in a specialized nursing home.

Infection

Moderate to severe head injuries often involve wounds or bone fractures, which can provide an opportunity for bacteria to enter the body through a break in the skin. As a result, infections can occur after a head or brain injury.

Prognosis

Children with minor head injuries and those without any brain damage generally make a full recovery without any long-term complications. Outcomes for severe head injuries, especially if there is brain damage, depend on the severity of the brain damage and presence of any other complications.

Prevention

To help prevent head injuries from occurring in children under your care, you can:

• Childproof your home to prevent household accidents;
• Ensure the use of appropriate safety headgear when riding a bike, skating, skateboarding, snowboarding, skiing or playing contact sports;
• Ensure the use of protective headwear or a specialized helmet in children who are recovering from a previous head injury, or are prone to bumping their heads;
• Avoid placing babies or toddlers on high pieces of furniture, and supervise them at all times while in a highchair or using play equipment;
• Strap your child into their stroller and high chair;
• If you have a play gym, cover the area under and around it with soft materials, and;
• Always use a seatbelt or child safety seat during car trips.

References

1. Clinical Practice Guidelines : Head Injury Guideline.Accessed September 26 2014. link here
2. Head Injuries. Accessed September 26 2014. link here
3. Head Injuries - First Aid. Better Health Channel. Accessed September 26 2014. link here
4. Head Injury. Accessed September 26 2014. link here
5. Head Injury (Brain Injury) Causes Symptoms Treatment - Head Injury Prognosis: Outlook and Recovery.” eMedicineHealth. Accessed September 26 2014. link here
6. Head Injury in the Child - Wheeless’ Textbook of Orthopaedics. Accessed September 26 2014. link here
7. Kids Health Info : Head Injury - General Advice. Accessed September 25 2014. link here

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