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Head Trauma

Kids are forever hitting their head. In fact almost a half-million kids wind
up in the emergency room each year with head injuries. Fortunately most of the
time an ice pack and a hug will take care of the situation quite nicely.
There are, however, times when a bump on the head can be something to worry about.
The article below will help you to learn more about pediatric head trauma,
and offer general guidelines for what to watch for when your child has a head injury.

Motor vehicle accidents, falls, sports injuries, assaults, and child
abuse are the most common causes of head injury in children and adolescents.
Motor vehicle accidents seem to result in a large number of hospital
admissions and death each year for children.

There are several types of injuries that make up the head trauma category.
Most obvious is skull fracture.  These occur less commonly in children than
in adults because the child's skull is more elastic.  The most frequent
type of fracture is the linear skull fracture.  Any skull fracture implies
enough trauma to potentially cause underlying brain injury.

Occassionally head trauma can result in seizures. These "posttraumatic seizures"
may be divided into early and late.  Early seizures occur within one week of the
trauma, usually within 24 hours, and are the result of focal injury to the brain. 
They usually do not require treatment but may recur in 25% of children. 
The late seizures are more problematic and usually occur more than a week after injury.


Cerebral contusion is a bruising of the brain resulting from blunt head
trauma or whiplash.  The degree of injury is more related to the
acceleration/deceleration forces than to the impact on the skull.  The child
may have a depressed level of consciousness, headache, and vomiting.

Subdural hematomas are more common than any of the previous injuries.  They
are collections of blood between the brain and its membranous covering.
They often occur with associated cerebral contusions following skull
fracture with tearing and leaking of blood vessels.  Large subdural hematomas may
require surgical intervention.

The most common type of head injury is a concussion.  As the word
itself implies, concussion is related to the brain being jiggled or
concussed within the closed skull from some external force, either directly
or indirectly.  This injury can cause loss of consciousness, depressed level
of consciousness, vomiting, headache, amnesia or ataxia (unsteady gate). 
Concussions come in all degrees from mild to severe.  Frequently they are
associated with sports, especially footbal, hockey and soccer.

 
Even the mildest concussion should require having a child remain out of sports for at
least 24 hours.  If any symptoms are persistent, play should be avoided
until the symptoms are completely gone for one full week.  Two episodes of
concussion with loss of consciousness should keep that youngster out of play
for the rest of the season.  There are even new studies that indicate that
resting the brain after head injuries should include limiting school work.
This has yet to be enthusiastically accepted by most educators.

For years physicians have been suspicious that certain concussions can cause
subtle decreases in intellect.  This can now be documented.  At the college
level many teams are doing baseline neuropsychological tests on all their
student-athletes before the season begins.  They then repeat the tests on
the field after a head injury and may find a significant change in the results. 
This does not mean that every injury causes permanent brain damage but
certainly a player should not return to play until his testing level is back to
baseline. It will probably be a while  before this type of testing makes
an appearance on the Pop Warner circuit.

When indicated, Computed tomography (CAT or CT Scan) is the procedure of
choice for evaluating head trauma in children especially if they have had loss of
consciousness, increasingly severe symptoms or open head wounds.  Regular
skull x-rays are rarely done any more.  If at any point your child is in a situation
where  you think a CT should be done and it is not, do not hesitate to ask for
an explanation as to why your child would not benefit from the CT. 
Chances are there is a logical explanation.

What can a parent look for at home in a child with a head injury to warrant a
visit to the doctor?

1)     decreased level of consciousness

2)      persistent vomiting (once or twice is acceptable)

3)      increasingly severe headache

4)      one eye pupil larger than the other in normal light

5)      any child with a head injury 6 months of age or younger

What can a parent do to prevent head injuries in their children?

1)     Seat Belts- See article on seat belt use for more specifics.

2)     Wear a helmet in any activity where your child can hit their head. Biking,
        skating, and yes even skatboarding. Don't forget ATV's (your children should
        not be on these super dangerous vehicles anyway), scooters, 
        and Go-Karts.      

What can a parent of a student-athlete do to increase the team's awareness of the
risks associated with head injury?

1)     Ask the coach his/her policy on dealing with head injury.

2)     Ask the coach if he/she is aware of "second impact syndrome" where a
        player who is returned to play sooner than appropriate after a head injury
        is at risk for sudden death if a second injury occurs.  Any coach who is
        aware of this should have a very reasonable approach to head trauma.

 
Remember that there is a reasonable way to manage most head trauma so do not
hesitate to ask questions and do not be afraid to tell anyone that you read
it here.



Helpful links for this topic:

Kid's Health

American Academy of Pediatrics