Head injury: Treatment in Infants and Young Children

Picture of Head Injury Patient

A head injury is any sort of injury to your brain, skull, or scalp. This can range from a mild bump or bruise to a traumatic brain injury. Common head injuries include concussions, skull fractures, and scalp wounds. The consequences and treatments vary greatly, depending on what caused your head injury and how severe it is.

Head injuries may be either closed or open. A closed head injury is any injury that doesn’t break your skull. An open, or penetrating, head injury is one in which something breaks your skull and enters your brain.

It can be hard to assess how serious a head injury is just by looking. Some minor head injuries bleed a lot, while some major injuries don’t bleed at all. It’s important to treat all head injuries seriously and get them assessed by a doctor.

Head Injury First Aid

A head injury is any trauma to the scalp, skull, or brain. The injury may be only a minor bump on the skull or a serious brain injury.

Head injury can be either closed or open (penetrating).

  • A closed head injury means you received a hard blow to the head from striking an object, but the object did not break the skull.
  • An open, or penetrating, head injury means you were hit with an object that broke the skull and entered the brain. This is more likely to happen when you move at high speed, such as going through the windshield during a car accident. It can also happen from a gunshot to the head.

Head injuries include:

  • Concussion, in which the brain is shaken, is the most common type of traumatic brain injury.
  • Scalp wounds
  • Skull fractures

Head injuries may cause bleeding:

  • In the brain tissue
  • In the layers that surround the brain (subarachnoid hemorrhage, subdural hematoma, extradural hematoma)

Head injury is a common reason for an emergency room visit. A large number of people who suffer head injuries are children. TBI (traumatic brain injury) accounts for over 1 in 6 injury-related hospital admissions each year.

What Are the Signs and Symptoms of a Brain Injury?

Signs of a TBI include:

  • Confusion
  • Depression
  • Dizziness or balance problems
  • Double or fuzzy vision
  • Feeling foggy or groggy
  • Feeling sluggish or tired
  • Headache
  • Memory loss
  • Nausea
  • Sensitivity to light or noise
  • Sleep disturbance
  • Trouble concentrating
  • Trouble remembering

Indications that a head injury is more serious than a concussion and requires emergency treatment include:

  • Changes in size of pupils
  • Clear or bloody fluid draining from the nose, mouth, or ears
  • Convulsions
  • Distorted facial features
  • Drop in blood pressure
  • Facial bruising
  • Fracture in the skull or face
  • Impaired hearing, smell, taste, or vision
  • Inability to move one or more limbs
  • Irritability
  • Loss of consciousness
  • Low breathing rate
  • Restlessness, clumsiness, or lack of coordination
  • Severe headache
  • Slurred speech or blurred vision
  • Stiff neck or vomiting
  • Sudden worsening of symptoms after initial improvement
  • Swelling at the site of the injury
  • Persistent vomiting

Head Injury in Infants and Young Children

Infants often visit health care practitioner because of a head injury. Toddlers tend to fall as they learn to walk, and falls remain the number one cause of head injury in children. While guidelines exist regarding the evaluation of head injury victims, they tend to be applied to those older than 2 years of age.

A minor head injury in an infant is described by the American Academy of Pediatrics as the following: a history or physical signs of blunt trauma to the scalp, skull, or brain in an infant or child who is alert or awakens to voice or light touch.

Infants are usually unable to complain about headache or other symptoms. Therefore, basic guidelines as to when to seek medical care can include the following:

  • Altered mental status. The child is not acting or behaving normally for that child.
  • Vomiting
  • Scalp abnormalities including lacerations and swelling that may be associated with skull fracture Forehead contusions tend to be less worrisome than occipital (back of the head) contusions
  • Seizure

Often a careful physical examination is all that is needed to assess the infant’s risk for intracranial hemorrhage, but some testing may be considered.

CT scan may be indicated based upon the health care practitioner’s assessment of the child. Plain skull X-rays may be considered to look for a fracture, as a screening tool to decide about the need for a CT scan.

Treating a severe head injury

Severe head injuries always require hospital treatment. This may involve:

  • observing the condition for any changes
  • running tests to check for further damage
  • treating any other injuries
  • breathing support (ventilation) or brain surgery

Most people are able to go home within 48 hours. However, a small number of those admitted to hospital require skull or brain surgery.

When you’re discharged from hospital, your doctor will advise you on the best way to help your recovery when you return home.

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