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Signs of head injury in baby


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.

Head Injuries (for Parents) - Nemours KidsHealth

What Are Head Injuries?

Head injuries are common in children and teens. They can hurt the scalp, skull, brain, or blood vessels.

Head injuries can be mild, like a bump on the head, or more serious, like a concussion. In kids, most are mild and don't injure the brain.

What Causes Head Injuries?

Most head injuries in childhood are due to falls. They also happen from:

  • car crashes
  • bike accidents
  • sports injuries
  • child abuse

What Are the Types of Head Injuries?

Head injuries can be: 

  • external and involve the scalp
  • internal and involve the skull, brain, or blood vessels

An injury can cause a concussion, contusion, fracture, or bleeding:

  • A concussion is a type of mild traumatic brain injury. It happens when a blow to the head or another injury moves the head back and forth with a lot of force. This causes chemical changes in the brain and sometimes damages brain cells.
  • A contusion (bruise) happens when a blow to the head injures the skin and the soft tissue under it. Blood from small blood vessels leaks, causing red or purple marks on the skin. Contusions often happen on the scalp or forehead. More serious head injuries can cause a brain contusion.
  • A skull fracture is a break in the skull bone. Skull fractures can happen in different parts of the skull.
  • Bleeding can happen on and under the scalp and in or around the brain. 

What Are the Signs & Symptoms of a Head Injury?

A child with a head injury might:

  • Have a swollen scalp: This is common because the scalp has many small blood vessels that can leak.
  • Have a headache: About half of children with a head injury get a headache.
  • Lose consciousness (pass out): This isn't common.
  • Vomit once or twice: This happens in some children after a head injury.

How Are Head Injuries Diagnosed?

Doctors diagnose head injuries by asking questions about how the injury happened and doing a careful exam of the head. They'll also check to see how the nerves are working.

Most children with a mild brain injury don't need medical tests. Doctors often do a CAT scan of the head if the injury is more serious.

Signs that the injury could be serious include:

  • loss of consciousness for more than a few minutes
  • continued vomiting
  • confusion
  • seizures
  • a headache that gets worse

What Should I Do When a Child Has a Head Injury?

Call your health care provider right away if your child had a head injury and:

  • is an infant
  • lost consciousness, even for a moment
  • has any of these symptoms:
    • won't stop crying
    • complains of head and neck pain (younger children who aren't talking yet may be more fussy)
    • vomits more than one time
    • won't awaken easily
    • becomes hard to comfort
    • isn't walking or talking normally

If your child is not an infant, has not lost consciousness, and is alert and behaving normally after the fall or blow:

  • Put an ice pack or instant cold pack on the injured area for 20 minutes every 3–4 hours. If you use ice, always wrap it in a washcloth or sock. Ice placed right on bare skin can injure it.
  • Watch your child carefully for the next 24 hours. If the injury happens close to bedtime or naptime and your child falls asleep soon afterward, check in a few times while they sleep.

If your child's skin color and breathing are normal, and you don't sense a problem, let your child sleep unless the doctor tells you otherwise. There's no need to keep a child awake after a head injury.

Trust your instincts. If you think your child doesn't look or seem right, partly awaken your child by sitting them up. They should fuss a bit and attempt to resettle. If your child still seems very drowsy, try to awaken them fully. If you can't wake your child, call your health care provider or 911 for an ambulance.

What Should I Do if a Child Is Unconscious After a Head Injury?

  • Don't move the child in case there is a neck or spine injury.
  • Call for help. If you have a phone with you, call 911.
  • If the child is vomiting or having a seizure, turn them onto their side while trying to keep the head and neck straight. This will help prevent choking and protect the neck and spine.

Can Head Injuries Be Prevented?

It's impossible to protect kids from every injury. But you can help prevent head blows. Most important, childproof your home to prevent household accidents.

Kids should:

  • Always wear a bike helmet that fits well and is approved by the U.S. Consumer Product Safety Commission for biking.
  • Use the proper sports equipment for inline skating, skateboarding, snowboarding, skiing, and contact sports.
  • Use a child safety seat or seatbelt every time they're in the car.
  • Take it easy after a head injury, especially if they had a concussion.
  • Wait until the doctor says it's OK before returning to rough play or sports. If the brain gets injured again while it's still healing, it will take even longer to completely heal.

Reviewed by: Kate M. Cronan, MD

Date reviewed: October 2019

Head injury in a child - first aid and diagnosis

The child grows and strives to explore the world. Childhood is the most dangerous period for a child. It is not uncommon for children to get head injuries.

Head injury is an injury to the head, skull. Traumatic brain injury ranks first in frequency of occurrence. It makes up 30–40% of the total number of patient visits. It is necessary to detect TBI in time, as the injury can cause irreparable harm to the health of the child.

Types of TBI in a child

1. Closed or open injury. In case of injury, the integrity of the soft tissues of the head is violated. There may be damage to the bones, a fracture of the base of the skull.

2. They are distinguished by severity:

  • Light degree. Damage is not accompanied by complications, more often it goes away without medical help. It is characterized by irritability, sleep disturbance, headache and dizziness for a short period of time.
  • Moderate - Severe contusion affecting the brain, such as a skull fracture. Damage can seriously affect your health. Doctors note mental disorders, memory loss, disturbed heart rhythm, paroxysms of the upper and lower extremities, disorders of the visual apparatus. Recovery takes several months
  • Severe. It is characterized by serious consequences that affect the quality of life of the victim. There is a possibility of death and coma. It is characterized by loss of sensitivity, deterioration of hearing and vision, disruption of the cardiac system, memory lapses, epileptic seizures.

3. By brain injury:

  • concussion;
  • contusion;
  • diffuse axonal injury;
  • squeezing.

Causes of head trauma in children

Injuries to the skull and brain are often caused by non-health causes:

  • fall;
  • accident;
  • a blow to the head.

Each age has different causes. A one-year-old child is just starting to walk, and this is not at all easy. He constantly falls, but stubbornly goes to his goal. Parents need to be especially careful and avoid head injuries. At an older age, children begin to go to kindergartens and schools. During this period, blows to the head during the game are possible. Accidents can also be accidents, which is especially dangerous for a child.

Symptoms of TBI

According to the symptoms, children can be divided into two groups:

  • up to two years, when the child cannot yet speak coherently;
  • after three, when the child can explain something.

The first group is characterized by the following symptoms:

  • crying;
  • lethargy;
  • drowsiness;
  • no reaction;
  • fever;
  • regurgitation.

For the second group:

  • headache;
  • dizziness;
  • lapses in memory;
  • nausea;
  • incoherent speech;
  • swallowing disorder;
  • fever.

First aid for cranial trauma

Call an ambulance. The health of your child depends on the speed of contacting a specialist. With late admission to the hospital department, complications may occur.

Before the ambulance arrives, you can do:

  • apply ice to the head;
  • move the child to the supine position;
  • unfasten clothing so that the child can breathe freely;

Diagnostics

In case of head injuries in a child, examinations are prescribed depending on the nature of the injury.

  • EEG. Identified disorders of the brain.
  • X-ray. The integrity of the skull is revealed.
  • Computed tomography. With its help, the state of the brain is determined.
  • Magnetic resonance imaging. Determines brain injury.
  • Ultrasound. Relevant for children up to a year.

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.

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.

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 is a fall from a small height (greater 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?

It is important to come to the emergency room in the following cases:

  • The injury was serious or the fall was from a significant height (more than a meter), even if the child looks perfectly healthy
  • The child suffers from severe prolonged headaches
  • The child suffers from nausea /vomiting for a long time
  • The child shows anxiety or vice versa indifference
  • There is a cut at the site of the injury that requires suturing or gluing
  • The injury occurred to an infant under the age of one year

Please note that there is a fee for visiting the emergency room.

How to recognize a concussion?

In more serious cases, signs of concussion may develop: persistent vomiting, significant dizziness without anatomical disturbances. A child who shows signs of a concussion will usually be hospitalized to monitor the progress of the problem. In most cases, after 24 hours of observation, the child will be discharged home.

How to make sure that there is no skull fracture?

In more serious cases, a skull fracture may occur. In most cases, we are talking about a "linear" fracture, that is, a crack. Diagnosis is by CT, in which case hospitalization is required for observation for several days to ensure that there are no signs of internal trauma.

When can a head injury be life-threatening?

Internal bleeding can be very dangerous and cause permanent damage or even death. The reason for this is the accumulation of blood in the intracranial box and its pressure on the soft tissues of the brain. Diagnosis of internal bleeding is done by CT of the brain. Bleeding inside the skull can be managed with emergency neurosurgery to drain blood and relieve pressure.

How to avoid such injuries?

It goes without saying that prevention is the most important thing. Falls from a bicycle, scooter or roller skates can be very dangerous if the child is not wearing a helmet. Therefore, it is very important to choose a helmet according to the size.

The head circumference of an adult is from 51 to 62 cm on average; in children from the age of 8 years, the head circumference reaches about 80 percent of its final size. On the packaging of the helmet, its girth in centimeters is indicated, as well as information about the size - small, medium, large.

When cycling, scootering or roller-skating, carefully fasten the helmet straps under the chin and turn your head to make sure that the helmet does not fall off. A helmet that is too large can be very dangerous and cause more damage in the event of an accident.

It is very important that the helmet be made of two types of material, or fused together, to make it resistant.

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