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The Informed Parent

Head Trauma

by Peter W. Welty, M.D., F.A.A.P.
Published on Oct. 22, 2001

We are all too familiar with the summertime sight of youngsters blazing down the sidewalks and streets on bicycles, skate boards or roller blades. Inevitably, some of those youngsters will have the misfortune of a FALL--and often the head is the focus of that injury.

Head trauma is a potentially serious health concern for all children; it causes approximately 200,000 hospitalizations per year for observation and treatment. Parents admit it is one of the leading causes of anxiety for them.

But parents can help immediately by keeping a checklist of findings. Some will mandate immediate attention, while others will allow for home observation under the care of the child's physician. After a child strikes his head, it is important to note his response--did he loose consciousness or did he cry immediately, the former requiring medical attention. One should look for swellings about the head. Large, soft water-like swellings need medical evaluation. It is the smaller swellings which cause the most concern for the parent. Generally, these become easier to assess as the evaluation is completed. One should look for confusion, abnormal behavior or movements, and difficulty speaking or seeing. These also require medical attention. The pupils of the eyes should be equal in size, and should become smaller when bright light is shined into them. Any suspicions should be reported to your physician. Also important to note any new drainage from the ears or nose, or if any vomiting occurs after the incident. One should evaluate the type of accident the child had and convey this information to the physician: the speed, length of fall, and degree of force. Neck pain should be evaluated for suspected injury and, if in doubt, medical attention should be sought prior to moving the child.

If all of the initial findings are normal, then a period of observation in concert with the child's physician is warranted. During this period a child may frequently want to sleep. This does not mean serious injury, but it is necessary to wake the child from sleep every two hours during the 24-to-48 hour period of observation.

In summary, medical attention should be obtained if any of the following are found:

  1. A period of unconsciousness or seizure activity.
  2. Confusion, abnormal behavior, difficulty seeing or speaking, or unsteadiness.
  3. Pupils of unequal size.
  4. Repeated vomiting.
  5. New drainage of fluid from the ear or nose.
  6. Neck pain or suspected neck injury.
  7. Large, soft water-like swellings on head.

Based on the information given to your child's physician, he may choose to evaluate the child immediately or allow for home observation, with close follow-up, should these symptoms change.
Fortunately, most head injuries do not cause serious problems. A good rule is to require helmet use when the child is involved in an activity that could cause head injury, such as bike riding, or rollerblading. If the parent is ever in doubt about the extent of the child's head injury, the physician should be contacted.

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