Head injury for infant

Head Injury in Children | Johns Hopkins Medicine

What is a head injury?

Head injuries are one of the most common causes of disability and death in children. The injury can be as mild as a bump, bruise (contusion), or cut on the head, or can be moderate to severe in nature due to a concussion, deep cut or open wound, fractured skull bone(s), or from internal bleeding and damage to the brain.

A head injury is a broad term that describes a vast array of injuries that occur to the scalp, skull, brain, and underlying tissue and blood vessels in the child's head. Head injuries are also commonly referred to as brain injury, or traumatic brain injury (TBI), depending on the extent of the head trauma.

What is a concussion?

A concussion is an injury to the head area that may cause instant loss of awareness or alertness for a few minutes up to a few hours after the traumatic event. Some concussions are mild and brief, and the person or untrained observer may not recognize that a concussion has occurred.

What is a contusion?

A contusion is a bruise to the brain. A contusion causes bleeding and swelling inside of the brain around the area where the head was struck, or sometimes on the opposite side of the head due to the brain hitting the skull.

What is a skull fracture?

A skull fracture is a break in the skull bone. There are 4 major types of skull fractures:

• Linear skull fractures. In a linear fracture, there is a break in the bone, but it does not move the bone. In many instances, these children can be observed in the emergency department or the hospital for a brief amount of time, and can usually resume normal activities in a few days. No interventions are usually necessary.

• Depressed skull fractures. This type of fracture may be seen with or without a cut in the scalp. In this fracture, part of the skull is actually sunken in from the trauma. If the inner part of the skull is pressed against the brain, this type of skull fracture requires surgical intervention to help correct the deformity.

• Diastatic skull fractures. These are fractures that occur along the suture lines in the skull. The sutures are the areas between the bones in the head that fuse with the growth of the child. In this type of fracture, the normal suture lines are widened. These fractures are more often seen in newborns and infants.

• Basilar skull fracture. This can be a serious type of skull fracture, and involves a break in the bone at the base of the skull. Children with this type of fracture frequently have bruises around their eyes and a bruise behind their ear. They may also have clear fluid draining from their nose or ears due to a tear in part of the covering of the brain. These children sometimes require close observation in the hospital.

What causes a head injury?

There are many causes of head injury in children. The more common injuries are sports injuries, falls, motor vehicle accidents (where the child is either riding as a passenger in the car or is struck as a pedestrian), or a result of child abuse.

The risk of head injury is high in the adolescent population and is twice as frequent in males than in females. Studies show that head injuries are more common in the spring and summer months when children are usually very active in outdoor activities such as riding bicycles, in-line skating, or skateboarding. The most common time associated with head injuries is late in the afternoon to early evening hours, and on weekends. Although usually not life threatening, head injury that occurs in competitive sports such as football, soccer, hockey, and basketball can result in concussion and postconcussive syndromes.

What causes bruising and internal damage to the brain?

When there is a direct blow to the head, shaking of the child (as seen in many cases of child abuse), or a whiplash-type injury (as seen in motor vehicle accidents), the bruising of the brain and the damage to the internal tissue and blood vessels is due to a mechanism called coup-countrecoup. A bruise directly related to trauma, at the site of impact, is called a coup lesion (pronounced COO). As the brain jolts backwards, it can hit the skull on the opposite side and cause a bruise called a countrecoup lesion. The jarring of the brain against the sides of the skull can cause tearing of the internal lining, tissues, and blood vessels that may cause internal bleeding, bruising, or swelling of the brain.

What are the symptoms of a head injury?

The following are the most common symptoms of a head injury. The child may have varying degrees of symptoms associated with the severity of the head injury. The symptoms of a mild head injury may include:

• Mild head injury:

  • Raised, swollen area from a bump or a bruise

  • Small, superficial (shallow) cut in the scalp

  • Headache

  • Sensitivity to noise and light

  • Irritability

  • Confusion

  • Lightheadedness and/or dizziness

  • Problems with balance

  • Nausea

  • Problems with memory and/or concentration

  • Change in sleep patterns

  • Blurred vision

  • "Tired" eyes

  • Ringing in the ears (tinnitus)

  • Alteration in taste

  • Fatigue or lethargy

• Moderate to severe head injury (that requires immediate medical attention)--symptoms may include any of the above plus: 

  • Loss of consciousness

  • Severe headache that does not go away

  • Repeated nausea and vomiting

  • Loss of short term memory, such as difficulty remembering the events that led right up to and through the traumatic event

  • Slurred speech

  • Difficulty with walking

  • Weakness in one side or area of the body

  • Sweating

  • Pale in color

  • Seizures or convulsions

  • Behavior changes including irritable

  • Blood or clear fluid draining from the ears or nose

  • One pupil (dark area in the center of the eye) looks larger than the other eye

  • Deep cut or laceration in the scalp

  • Open wound in the head

  • Foreign object penetrating the head

  • Coma (a state of unconsciousness from which a person cannot be awakened; responds only minimally, if at all, to stimuli; and exhibits no voluntary activities)

  • Vegetative state (a condition of brain damage in which a person has lost his thinking abilities and awareness of his surroundings, but retains some basic functions, such as breathing and blood circulation)

  • Locked-in syndrome (a neurological condition in which a person is conscious and can think and reason, but cannot speak or move)

How are head injuries diagnosed?

The full extent of the problem may not be completely understood right after the injury, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a head injury is made with a physical exam and diagnostic tests. During the exam, the doctor obtains a complete medical history of the child and family and asks how the injury occurred. Trauma to the head can cause neurological problems and may require further medical follow up.

Diagnostic tests may include:

• Blood tests

• X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

• Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

• Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays. Although an X-ray is useful when looking for a skull fracture, most skull fractures can also be detected by a CT scan, which also produces images of the brain. If a brain injury is suspected, a CT scan alone may be used to reduce the amount of radiation the patient receives,

• Electroencephalogram (EEG). A procedure that records the brain's continuous, electrical activity by means of electrodes attached to the scalp.

Treatment of a head injury

Your child’s health care provider will figure out the best treatment based on:

• How old child is

• His or her overall health and medical history

• How sick he or she is

• How well your child can handle specific medications, procedures, or therapies

• How long the condition is expected to last

• Your opinion or preference

Depending on the severity of the injury, treatment may include:

• Ice

• Rest

• Topical antibiotic ointment and adhesive bandage

• Observation

• Immediate medical attention

• Stitches

• Hospitalization for observation

• Moderate sedation or assistance with breathing that would require being placed on a breathing machine, also called a mechanical ventilator or mechanical respirator

• Diagnostic tests

• Surgery

• Referral to a traumatic brain injury specialist for postconcussive syndrome

Treatment is individualized depending on the extent of the condition and the presence of other injuries. If your child has a head injury, he or she may require monitoring for increased intracranial pressure (pressure inside the skull). Head injury may cause the brain to swell. Since the brain is covered by the skull, there is only a small amount of room for it to swell. This causes pressure inside the skull to increase, which can lead to brain damage.

How is ICP monitored?

Intracranial pressure is measured in two ways. One way is to place a small hollow tube (catheter) into the fluid-filled space in the brain (ventricle). Other times, a small hollow device (bolt) is placed through the skull into the space just between the skull and the brain. Both devices are inserted by the doctor either in the intensive care unit or in the operating room. The ICP device is then attached to a monitor that gives a constant reading of the pressure inside the skull. If the pressure goes up, it can be treated right away. While the ICP device is in place your child will be given medicine to stay comfortable. When the swelling has gone down and there is little chance of more swelling, the device will be removed.

Lifelong considerations for a child with a head injury

The key is to promote a safe playing environment for children and to prevent head injuries from occurring. The use of seat belts when riding in the car and helmets (when worn properly) for activities, such as bicycle riding, in-line skating, and skateboarding may protect the head from sustaining severe injuries.

Children who suffer a severe brain injury may lose part(s) of muscle, speech, vision, hearing, or taste function depending on the area of brain damage. Long- or short-term changes in personality or behavior may also occur. These children require lifelong medical and rehabilitative (physical, occupational, or speech therapy) management.

The extent of the child's recovery depends on the type of brain injury and other medical problems that may be present. It is important to focus on maximizing the child's capabilities at home and in the community. Positive reinforcement will encourage the child to strengthen his or her self-esteem and promote independence.

What to Look For and When to Seek Help

You see baby teeter, then totter, and then — in a “Matrix”-like moment that somehow occurs both in slow motion and in the blink of an eye — they tumble. Oh, the screams. The tears. And a big goose egg that’s growing by the second.

We know how scary it can be when your precious baby bumps their head. And if you’re living this right now — icing your little one’s knot while searching for what to do next — you’re in the right place.

First, take a deep breath and try to remain calm. Most of the time, fall-related bumps to the head are minor and don’t require medical attention.

In fact, this 2015 study concluded that fall-related head injuries in young children don’t usually cause serious harm.

At the same time, the Centers for Disease Control and Prevention states that falls are the leading cause of traumatic brain injury-related emergency department visits up in children up to age 4. Keep in mind that this is rare.

So in the rarer case, there are a few cues that should alert you to seek emergency medical help.

First, some reassuring stats: According to one study on short falls in young children, only about 2 to 3 percent of falls lead to a simple linear skull fracture, and most of these don’t cause neurological problems. Only about 1 percent of skull fractures related to accidental falls cause moderate to severe brain injury.

That said, it’s still important to be aware of the symptoms of a traumatic brain injury, including concussions, which usually present within 24 to 48 hours of the accident.

If your baby is showing any of these symptoms after experiencing an injury to their head, call 911 or take them to the nearest emergency room immediately:

• uncontrolled bleeding from a cut
• a dent or bulging soft spot on the skull
• excessive bruising and/or swelling
• vomiting more than once
• unusual sleepiness and/or difficulty staying alert
• loss of consciousness or not responding to voice/touch
• blood or fluid draining from the nose or ears
• a seizure
• a suspected neck/spinal cord injury
• trouble breathing

Accidental bumps to the head are one of the most common injuries among infants and toddlers. But this fact alone might not stop you from continuously replaying the scene in your head while thinking about how you would rewrite the ending.

But a fall-related knock to the noggin is often largely due to a baby’s physical stature and development — not your parenting. Babies’ heads are often proportionally larger than their bodies, making it easier for them to lose their balance.

In addition, babies’ physical strength and abilities are constantly changing, which affects their stability and coordination. The same adorable wobbly walk could put them in harm’s way when encountering a new, uneven surface or a fun object to run toward.

This, coupled with a baby’s tendency to engage in more daredevil acts that have them climbing, jumping, or trying to fly just for the thrill, can be the perfect equation for a nasty plunge. In fact, babies are notorious for these common head injury culprits:

• slipping in the tub
• falling backwards
• falling off a bed or changing table
• falling after climbing on furniture or up on countertops
• falling in or out of the crib
• tripping over rugs or objects on the floor
• falling down steps or stairs
• falling while using an infant walker (one of the reasons why such walkers are considered unsafe)
• falling from playground swing sets

The height from which a baby falls is correlated to the severity of injury, so if your child fell from a higher distance (such as from a crib or countertop) they’re at a greater risk of serious injury.

The term “head injury” encompasses the entire range of injuries, from a small forehead lump to a traumatic brain injury. Most short fall-related injuries among babies fall under the “mild” category.

Mild head injuries

Mild head injuries are considered closed, meaning they don’t involve any skull fractures or underlying brain injury. In these cases, swelling and a large “bump” or bruise on the skin may appear without any further symptoms.

If your baby’s fall resulted in a cut or laceration, there may be significant bleeding that requires medical attention to clean and suture the wound, even if there’s no brain or skull injury.

After a bump to the head, babies can experience a headache and discomfort. However, at this age, it’s difficult for them to communicate this feeling. It might surface as increased fussiness or difficulty sleeping.

Moderate to severe head injuries

Moderate to severe brain injuries represent the minority of those related to infant falls. They can involve:

• skull fractures
• contusions (when the brain is bruised)
• concussions (when the brain is shaken)
• bleeding in the brain or around the layers surrounding the brain

Concussions are the most common and least severe type of traumatic brain injury. A concussion can affect multiple brain regions, causing problems in brain function. Signs of a concussion in children can include:

• headaches
• loss of consciousness
• changes in alertness
• nausea and vomiting

While super rare, more severe injuries can involve a fracture of the skull, which can put pressure on the brain and also cause swelling, bruising, or bleeding around or inside of the brain. These are the most serious circumstances that require emergency medical attention.

It’s critical that medical treatment is administered as soon as possible to reduce the potential for long-term brain damage and loss of physical and cognitive function.

In most cases, “watch and wait” (with lots of extra TLC) is the most appropriate course of action after a baby’s minor head bump.

Keep the symptoms of a more serious head injury in mind, watching for any changes in behavior or neurological deficits within 48 hours of the accident.

Other ways to care for your injured little one during the watch and wait period:

• apply ice as tolerated by your baby
• clean and bandage any minor cuts or abrasions to the skin
• check for changes/consistency in the size of your baby’s pupils
• monitor your baby while they’re sleeping during naps and at night
• call your baby’s pediatrician for guidance if you’re concerned

When to call your child’s pediatrician

You know your baby best, so if you’re even remotely worried, don’t hesitate to call your child’s pediatrician for expert advice on what to do next. They might want to evaluate your baby out of precaution and to document the injury for their medical record.

To evaluate for a head injury, the pediatrician or emergency room doctor will likely ask you about how the injury occurred, what your baby was doing before the injury, and what symptoms your baby experienced after the injury.

They might also do a series of neurological exams — looking at your baby’s eyes and responses to voice and touch — and a general physical exam, too.

If something in this exam triggers concern of a serious brain injury, the doctor may order an imaging test such as a CT scan. CT scans are usually only performed when there’s evidence of a severe brain injury.

Although rare, the doctor may advise you to go to the nearest emergency room for more immediate evaluation, diagnosis, or critical care. Or, they may want to observe your baby for a few hours during a medically supervised “watch and wait” period.

Treatment for head injuries depend on the severity. In mild cases, ice, rest, and extra cuddles are the best medicine. (Not a bad treatment for adult head bumps, either. )

After a concussion, frequent monitoring might be advised by your baby’s pediatrician, as well as activity restrictions.

For more serious injuries, it’s important to follow a doctor’s direction. Usually, only severe traumatic head injuries require critical hospital-based intervention that can include medical and surgical treatments as well as physical therapy.

Most minor bumps to the head in young children don’t pose any risk of long-term complications, thank goodness.

But there is a body of research that does bring to light long-term concerns with even minor traumatic brain injuries. A 2016 study that followed a Swedish cohort concluded a possible correlation between a traumatic brain injury (including mild concussions) in childhood with an increased risk for mental health problems, disability, and even mortality into adulthood. As you may expect, children with multiple head injuries had even greater long-term risks.

The American Academy of Pediatrics echoes this with research presented at its 2018 national conference. In the study of children diagnosed with a traumatic brain injury from mild to severe, 39 percent developed neuropsychiatric symptoms up to 5 years after the injury, such as headache, mental disorder, intellectual disability, depression/anxiety, seizure, or brain damage.

This message is empowering to help prevent more serious accidental falls that could affect your little one’s health, growth, and development.

While a minor head bump is bound to happen from time to time, here are a few tips to help keep your baby out of harm’s way.

• Install and secure baby gates on the top and bottom of stairs.
• Watch for wet areas on hard floors (especially around pool and bath surfaces).
• Install non-skid mats in the bathtub and rugs on the bathroom floor.
• Firmly secure furniture to walls.
• Keep young children away from dangerous things to climb.
• Don’t sit or leave your baby up on countertops.
• Avoid using infant walkers with wheels.
• Remove tripping hazards.
• Be cautious at playgrounds that don’t have softer surfaces.

There’s no doubt about it — when your baby takes a tumble, their tears can equal fears and tears of your own. It’s normal to worry, but rest assured that most minor bumps to the head don’t cause a serious brain injury or require emergency medical attention.

However, there are rare instances where a more serious traumatic brain injury can result. In this case, know the symptoms to watch for and always call your child’s pediatrician or seek emergency medical care if you feel it’s necessary.

Read this article in Spanish.

Children's head injuries | Kaplan Medical Center

Head injuries are very common in children, but 60% of them are mild and do not cause any damage. In most cases, the infant or child will cry out of surprise from the pain resulting from the impact, but very soon the crying will stop and the child will continue to act normally. Thus, most cases do not require special treatment or any checks, other than the observation of parents at home. nine0003

Is a hematoma (bruise) in the area of ​​impact dangerous?

Bumps usually show no outward signs other than some redness or superficial abrasions. Sometimes a red-blue swelling may occur at the site of impact, which means subcutaneous hematoma in the area of ​​impact. The occurrence of a hematoma is not surprising, because the scalp area is abundantly covered with blood vessels. Therefore, if an external injury occurs, the bleeding from it will be relatively large compared to similar injuries in other parts of the body, and the internal injury will be a subcutaneous hematoma. nine0003

How to treat a hematoma?

Attach something cold wrapped in cloth.

How to stop bleeding?

If there is external bleeding from the wound, apply pressure to the impact site with a piece of a stamp or other tissue.

When can you calm down and understand that we are talking about a slight bruise?

In the following cases, you can understand that this is a minor injury and that you can monitor the child at home:

• This refers to a fall from a small height (large height - more than a meter in infants under two years of age).
• Injury not the result of a traffic accident
• No significant penetrating injury
• Injury not the result of bullying (in any case of suspicion of intentional injury, fundus examination should be performed and reported to a social worker)
• No signs of loss of consciousness or seizures
• Child behaves normally again after a few minutes
• The child did not vomit more than twice after the injury
• The injury did not develop a prolonged or significant headache

When can a child be allowed to sleep after a head injury?

A child can sleep after a head injury, sleep will not hurt him. However, if it seems to parents that drowsiness is significantly increased, so much so that it is difficult to wake the child, you should go to the emergency room.

When should I arrive for an examination in the emergency room? nine0006