Understanding Head Trauma in Children

Toddlers hit their heads often. They fall, trip, roll, and stumble. The sound of a head hitting the floor or wall can be a gut-wrenching noise. Before you panic, thinking that your child may have done serious damage, look at her. The best sign that there is nothing to worry about is that your child cries immediately, then calms down and goes back to her usual activity. Even if a big mp (often referred to as a “goose egg”) emerges within minutes, her head is probably fine. In fact, goose eggs tend to be reassuring, because the swelling is heading outward onto the scalp and not inward toward the brain.

Trauma is the leading cause of injury and death in children younger than 16 years of age. Children have a higher risk of head injury in accidents than adults. This is partly because they have larger heads (relative to their body size) and underdeveloped neck muscles.

Head trauma, in the most general terms, is classified as mild, moderate, or severe. One type of mild to moderate head injury is called concussive injury or concussion. A concussion is defined as a head injury associated with any of the following: loss of consciousness, amnesia, seizure, or altered mental status. If your child has a concussion, she may complain of a headache, visual changes, dizziness, or ringing in the ears. She might have poor balance, confusion, or difficulty concentrating.

A child who has had a concussive injury is at increased risk of more significant damage with a second head trauma in the initial six months following the first event. This is why a child who sus­tains a concussion should not be involved in activities that put her at risk of another head injury for the next six months, includ­ing sports such as soccer, football, and gymnastics.

A severe head injury can result in bleeding inside the skull. When the bleeding occurs between the covering of the brain (called the dura) and the brain itself, the injury is called a sub­dural hematoma (a hematoma is a blood collection). Most fre­quently, the bleeding occurs here when there is a tear in a vein along the surface of the brain. The subdural bleeding that follows head trauma may be sudden and large, or it may be slow and chronic.

Another type of bleed is an epidural hematoma. Here bleed­ing occurs between the dura surrounding the brain and the skull bones, causing blood to collect around the outside of the brain. This is notably different from a subdural hematoma because it cannot cause bleeding within the tissue of the brain. And unlike a subdural hematoma, which is caused by a broken vein, an epidural hematoma usually (but not always) results from a torn artery. Because arteries carry “high-pressure” blood, these bleeds tend to be sudden and large.

Finally, there is an intraparencbymal hemorrhage (or cere­bral contusion). This is bleeding in the brain tissue itself — not near the skull, but deep in the brain. Think of it as a bruise in the brain tissue. The degree of intraparenchymal hemorrhage can range from a mild bruise to a large clot or hematoma.

Most signs that a head trauma might have caused a concussion or a bleeding injury appear within six hours of the injury. (In rare cases, they can appear 24 to 48 hours later.) These include loss of consciousness immediately after the trauma, seizure, abnormal behavior, vomiting, or inappropriate sleepiness. The sleep issue can be difficult to assess because most toddlers are due for a nap or bedtime within six hours of an injury. Appropriate sleepiness according to your child’s regular schedule is not cause for con­cern unless it is coupled with other signs.

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