Head Trauma in Young Children

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          Young children frequently hit their heads. Head trauma in this age group is usually minor and rarely results in serious brain injury. The most common cause of injury in very young children is falls. Over two years of age, motor vehicle accidents, bicycle accidents and sports accidents are common causes. Evaluation of children less than two year of age is more difficult because they cannot report symptoms such as headache and confusion. In this age group, a sign of more serious injury can be a large, soft swelling under the scalp called a hematoma. Parents should be concerned if a younger child has a fall from a significant height, if there is any loss of consciousness longer than a few seconds or if vomiting occurs after the trauma. Any change in a child’s behavior that occurs after head trauma should be investigated by the child's care-giver.             
         Young children are at greater risk for concussion, so parents should never hesitate to have a child examined after significant head trauma. Irritability, lethargy, unsteady gait or increasing clumsiness are symptoms which should prompt the parent to seek medical care. For the older child, there are some rules of thumb parents can use to evaluate the degree of trauma the child sustained:

                  1.   Loss of consciousness: The longer loss of consciousness, the more concern.    

                  2.     Loss of memory: The child can’t remember the details of the accident or, even more worrisome, the child can’t remember what occurred before or after the accident.

                  3.     Prolonged symptoms: If headache, confusion or other symptoms continue to persist after the accident, there is greater concern.

                  4.     Increasing symptoms: If vomiting, headache or other symptoms are gradually increasing, there is real concern. The child needs to be examined immediately.
        Any older child who has had head trauma from sports needs to be taken from the game and not allowed to play until the parent gets an O.K. from the child's care-giver.

      CT scan of the head is ordered if bleeding inside the head is suspected. CT scan does not show concussion. Because of the risk of radiation, CT scans must only be done when necessary and, if done, they must be done carefully. There are clear guidelines for how much radiation to use when doing these procedures on children, but they often are not followed, especially in hospitals that are not pediatric specialty hospitals. Regular X-ray studies are usually not necessary.

     If a child had a low-risk injury, did not lose consciousness, has no vomiting, no headache, no large scalp swelling and has no change in their normal mental status, it is usually safe to observe the child. Allow the child to do normal activity but refrain from activity which could cause another head injury. You don’t need to wake the child from sleep to monitor them, however, if the child wakes up spontaneously with pain, he needs to be examined.