Head Injuries In Children: Signs, Causes And When To Worry

Head injury is a broad term representing a wide range of injuries to the skull, brain, underlying tissues, and blood vessels. An injury can be mild, with a bump or bruise on the head or a serious one, which causes severe brain injury, concussion, or bleeding. Although often invisible, serious head injuries in children can be life-threatening, causing permanent neurological impairments (1).

Read on to learn more about the types, symptoms, diagnosis, complications, and management of head injuries in children.

Types Of Head Injuries In Children

A head injury can be of an open type or closed type. An open head injury occurs when an object hits the head and penetrates the skull. This type of injury is considered severe. A closed head injury occurs when an object hits the scalp but does not break the skull (2).

Below are the common types of head injuries (3).

• Scalp injury: The damage to the scalp can be in the form of a cut, scrape, bruise, or swelling. Normally, the penetration of the scalp can lead to heavy bleeding that might require stitching in the E.R.
• Concussion: Concussion is a type of head injury where the brain moves or jolts within the skull due to a sudden impact on the head, which can cause brain swelling. The swelling is often not life-threatening by itself, but it can temporarily affect the functioning of the brain, causing headaches, confusion, nausea, and vomiting until it heals.
• Skull fracture: It is a severe type of head injury where the skull breaks or fractures. Any injury that fractures a skull is potentially life-threatening and must be evaluated by a health professional.
• Contusion: A brain contusion is a bruise to the brain that typically occurs due to a hard blow to the skull. Its implications can be serious because of secondary uncontrolled bleeding and/or heavy swelling. Since the brain is encased in a rigid skull, it does not have any space to expand, and blood flow to it can become impaired.

Causes Of Head Injuries In Children

Head injuries occur due to an impact on the head. Below are the common events that may cause an impact on a child’s head (1).

• Falls: Falling from a height, tripping over, and slipping are the most common causes of head injuries in children.
• Sports-related accidents: Sports-related head injuries may occur due to getting hit by a ball, getting tackled, bumping into other children, or falling while cycling or skating.
• Motor vehicle accidents: These injuries occur due to traffic accidents and include accidents due to pedestrians struck by a vehicle.
• Child abuse or violence: According to a CDC study, child assault accounted for about 42% of traumatic brain injury-related deaths in children between 2006 and 2010 in the US (4). Head injuries due to shaking are common among infants and toddlers.

Symptoms Of Head Injuries In Children

The symptoms of head injury in children could vary depending on the severity of the injury.

Mild head injury may cause the following symptoms (3) (5).

• A swelling or bump on the head
• Bruise in the forehead or head extremities
• Perplexed behavior
• Difficulty thinking
• Lightheadedness
• Frequent headaches
• Nausea and vomiting
• Feeling tired and lack of energy
• Anxiety and nervousness
• Drowsiness
• Irritability

Moderate to severe head injury may cause the above symptoms as well as the following ones.

• Large wound with visible underlying tissue
• Long-lasting headaches
• Weakness in one side of the body
• Blood or fluid discharge from ears or nose
• Short-term memory loss
• Unresponsiveness
• Loss of consciousness
• Memory problems
• Seizures

When To See A Doctor

The symptoms of a head injury may resemble those of other conditions. Also, it may not always be clear whether the symptoms are due to a minor or major head injury. Therefore, if your child sustained a head injury or you suspect a head injury due to an accident or event, take your child to a doctor.

You must take the child to the emergency ward in the following cases (2) (6).

• Head injury after a motor vehicle crash or after a fall from a height of more than one meter.
• Severe headaches
• Bleeding
• Seizures
• Vomiting
• Difficulty breathing
• Your child seems to lose memory or consciousness.
• You notice behavioral or speech changes
• Severe Drowsiness
• Irritability

Therefore, if you have any doubt whether the injury is severe or not, it is best to take your child to an E.R. to get them checked.

Diagnosis Of Head Injuries In Children

The diagnosis of head injuries in children is made by a healthcare professional. Physical examination is done to check the extent of tissue damage after a head injury. The doctor may test the child’s vision, hearing ability, balance, and reflexes.

The doctor may suggest an X-ray, MRI, or CT scan, depending on the child’s symptoms. Blood tests may also be conducted to check for biomarkers that can indicate brain injuries (7) (8).

Complications Of Head Injuries In Children

A head injury may lead to complications immediately after an injury or later, depending on the area of brain damage and the severity of the injury. The possible complications that may arise as a result of a head injury in children are (9) (10):

• Personality and behavioral changes
• Inability to process information
• Changes in hearing, vision, and taste
• Motor and intellectual disabilities
• Sudden seizures (post-traumatic epilepsy)
• Defects in the skull
• Fluid build-up in the brain cavities (leading to a condition called hydrocephalus)
• Leakage of cerebrospinal fluid (CSF)
• Cranial or vascular nerve damage, leading to infections
• Intracranial hemorrhage (ICH) (caused by bleeding inside the skull)

Treatment For Head Injuries In Children

Treatment options are chosen based on the child’s age and the head injury’s severity. Mild head injuries may require wound dressing at an outpatient clinic. However, severe head injuries may require hospitalization with surgical interventions for wound repair and prevention of complications. Medications may also be prescribed to ease swelling and help in the healing process.

If your child had a head injury, you might follow certain first-aid methods to make them feel better before you take them to a doctor (11) (12).

• Apply an ice pack to reduce swelling and discomfort.
• If your child is bleeding, control the bleeding by pressing a clean cloth on the wound. Don’t touch the wound if it is open. Instead, cover it with a bandage and visit a doctor. Severe wounds may require stitches.
• Minor scalp cuts or wounds can be treated with an adhesive bandage and topical application of ointments.
• If your child is unconscious, they may have a serious underlying injury. Contact your local health provider as soon as possible.

While you may treat minor head injuries at home with minimal care or treatments, you need to monitor your child closely. Seek medical care if you feel your child’s symptoms have worsened or their condition is severe.

Prevention Of Head Injuries In Children

It is hard to keep children injury-proof at all times. But you may consider taking certain preventive measures to reduce the risk of head injuries in your child (13).

• Childproof your house to avoid house-related accidents, such as falls from furniture or injuries due to a piece of furniture falling on the child.
• Install window guards and set up safety gates at the top and the bottom of the stairs.
• Make sure your child’s beds are firm to prevent falls.
• While outdoors, your child must always follow road safety rules.
• Check if the outdoor play surfaces are soft and are safe for your child’s playing.
• Your child should wear a well-fitted helmet while riding a bicycle or skating.
• Ensure your child wears properly-fitted protective gear while playing sports that make the player susceptible to head injuries.
• Your child must follow car safety rules by wearing seat belts all the time while traveling in a car or other motor vehicle.
• Refrain from driving when you are tired, have consumed alcohol, or taken drowsiness-inducing or illegal drugs.
• If your child had a head injury in the past, wait until their doctor gives them the go-ahead to return to playing.

References

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