Robert Wood Johnson University Hospital
 

Head Injury

Head Injury

What is a head injury?

Head injuries are one of the most common causes of disability and death in children. The injury can be as mild as a bump, bruise (contusion), or cut on the head, or can be moderate to severe in nature due to a concussion, deep cut or open wound, fractured skull bone(s), or from internal bleeding and damage to the brain. The CDC estimates that traumatic brain injury results in almost half a million (473,947) emergency department visits in children up to 14 years of age.

A head injury is a broad term that describes a vast array of injuries that occur to the scalp, skull, brain, and underlying tissue and blood vessels in the child's head. Head injuries are also commonly referred to as brain injury, or traumatic brain injury (TBI), depending on the extent of the head trauma.

What is a concussion?

A concussion is an injury to the head area that may cause instant loss of awareness or alertness for a few minutes up to a few hours after the traumatic event.

What is a contusion?

A contusion is a bruise to the brain. A contusion causes bleeding and swelling inside of the brain around the area where the head was struck.

What is a skull fracture?

A skull fracture is a break in the skull bone. There are four major types of skull fractures, including the following:

What causes a head injury?

There are many causes of head injury in children. The more common injuries are falls, motor vehicle accidents (where the child is either riding as a passenger in the car or is struck as a pedestrian), or a result of child abuse.

The risk of head injury is high in the adolescent population and is twice as frequent in males than in females. Studies show that head injuries are more common in the spring and summer months when children are usually very active in outdoor activities such as riding bicycles, in-line skating, or skateboarding. The most common time associated with head injuries is late in the afternoon to early evening hours, and on weekends.

What causes bruising and internal damage to the brain?

When there is a direct blow to the head, shaking of the child (as seen in many cases of child abuse), or a whiplash-type injury (as seen in motor vehicle accidents), the bruising of the brain and the damage to the internal tissue and blood vessels is due to a mechanism called coup-countrecoup. A bruise directly related to trauma, at the site of impact, is called a coup lesion (pronounced COO). As the brain jolts backwards, it can hit the skull on the opposite side and cause a bruise called a countrecoup lesion. The jarring of the brain against the sides of the skull can cause shearing (tearing) of the internal lining, tissues, and blood vessels that may cause internal bleeding, bruising, or swelling of the brain.

What are the symptoms of a head injury?

The following are the most common symptoms of a head injury. However, each child may experience symptoms differently. The child may have varying degrees of symptoms associated with the severity of the head injury. The symptoms of a mild head injury may include:

How are head injuries diagnosed?

The full extent of the problem may not be completely understood immediately after the injury, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a head injury is made with a physical examination and diagnostic tests. During the examination, the doctor obtains a complete medical history of the child and family and asks how the injury occurred. Trauma to the head can cause neurological problems and may require further medical follow up.

Diagnostic tests may include:

Treatment of a head injury

Specific treatment of a head injury will be determined by your child's doctor based on:

Depending on the severity of the injury, treatment may include:

Treatment is individualized depending on the extent of the condition and the presence of other injuries. If your child has a head injury, he or she may require monitoring for increased intracranial pressure (pressure inside the skull). Head injury may cause the brain to swell. Since the brain is covered by the skull, there is only a small amount of room for it to swell. This causes pressure inside the skull to increase, which can lead to brain damage.

How is ICP monitored?

Intracranial pressure is measured in two ways. One way is to place a small hollow tube (catheter) into the fluid-filled space in the brain (ventricle). Other times, a small hollow device (bolt) is placed through the skull into the space just between the skull and the brain. Both devices are inserted by the doctor either in the intensive care unit or in the operating room. The ICP device is then attached to a monitor that gives a constant reading of the pressure inside the skull. If the pressure goes up, it can be treated right away. While the ICP device is in place your child will be given medicine to stay comfortable. When the swelling has gone down and there is little chance of more swelling, the device will be removed.

Lifelong considerations for a child with a head injury

The key is to promote a safe playing environment for children and to prevent head injuries from occurring. The use of seat belts when riding in the car and helmets (when worn properly) for activities such as bicycle riding, in-line skating, and skateboarding may protect the head from sustaining severe injuries.

Children who suffer a severe brain injury may lose part(s) of muscle, speech, vision, hearing, or taste function depending on the area of brain damage. Long- or short-term changes in personality or behavior may also occur. These children require lifelong medical and rehabilitative (physical, occupational, or speech therapy) management.

The extent of the child's recovery depends on the type of brain injury and other medical problems that may be present. It is important to focus on maximizing the child's capabilities at home and in the community. Positive reinforcement will encourage the child to strengthen his or her self-esteem and promote independence.

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