Since young children always seem to be falling down, bumping their heads, and running into things, it’s no surprise that head injuries (head and brain trauma) are a common occurrence during childhood. In most cases, these injuries probably aren’t serious. But in other cases, a child may sustain severe brain trauma and need immediate medical help.
A head injury may be external or internal. An external injury usually involves the scalp, and may show external signs like bleeding or a lump. An internal head injury is often more serious, and may be life-threatening, as it can affect the skull or brain. A concussion is an internal head injury.
The following are symptoms of a serious head injury. If your child exhibits any of these symptoms after a head trauma incident, you should take him or her to see a doctor:
- Constant headache that seems to be getting worse
- Neck pain or stiffness
- Recurring or long-lasting dizziness
- Stumbling, having trouble walking and/or balancing
- Impaired or slurred speech
- Blurry vision or double vision
- Ringing in the ears
- Impaired hearing
- Unusual paleness lasting for over an hour
- Unequal pupil sizes
- Damaged motor coordination
- Weakness in the arms or legs
- Fatigue, extreme sleepiness, or trouble waking up
- Behavioral changes such as mood swings, extreme irritability, depression, anxiety, or restlessness
- Confusion or cognitive problems: such as short-term memory loss, trouble concentrating or thinking, impaired communication skills, limited attention span, or difficulty with reading and writing
In addition, the following symptoms may signify more severe internal brain trauma. If your child experiences any of these, you should call 911 or take your child to the hospital immediately:
- Unconsciousness that lasts for more than a few seconds
- Vomiting more than two or three times
- Watery fluid or blood oozing from the nose, ears, or mouth
- Seizures or convulsions
The Glasgow Coma Scale (GCS) is a system for assessing head trauma, and describes an injury using a score. For example, minor head trauma for children age two and older usually scores between 13 and 15. This score might refer to a head injury that occurs without fracturing the skull, and which yields no abnormal results in a neurologic examination.
Children with mild traumatic brain injuries may also score around 13 to 15 on the GCS scale. A mild traumatic brain injury may include disorientation, vomiting, or a brief loss of consciousness.
A lower GCS score reflects a more serious injury, so children with moderate traumatic brain injuries may score between 9 and 12. Severe traumatic brain injuries usually score an 8 or lower.
CT imaging can potentially put a child at greater risk for lethal malignancy. This risk decreases with age, so physicians should assess a young patient carefully before deciding to obtain a CT. The Pediatric Emergency Care Applied Research Network (PECARN) has developed a system for determining whether or not to obtain a CT for a young child with head trauma.
PECARN recommends a CT for children with a GCS score of 14, children with a skull fracture, or children who have experienced a changed mental state after head trauma.
A CT scan may also be a good idea for children with parietal or temporal scalp haematoma, children with severe mechanism of injury, or children who are acting abnormally, have a severe headache or vomiting, or have lost consciousness for more than five seconds. Whether or not a child in this condition should have a CT will be based on certain criteria like age (older or younger than three months), the experience level of the physician, whether symptoms are isolated or not, and the presence of worsening symptoms.
Treatment and long-term effects
If your child has a minor head injury, you can usually treat it with an icepack, but should watch the child for 24 hours after the incident to ensure no worse symptoms develop.
On the other hand, if more serious symptoms develop (or if the child is an infant), you should call your child’s doctor. If a child loses consciousness, you should call 911. Do not move an unconscious child, as he or she may have a spinal or neck injury.
Children with a serious brain injury may experience cognitive changes that can last for a long time after the incident. These include impaired reasoning and judgment and difficulty processing information, as well as short-term memory loss and other changes. In young children, these signs are sometimes difficult to recognize, and may only become noticeable as a child gets older.