What Is It?
Trauma to the head can cause a range of medical and surgical problems, ranging from mild to severe. Each year, childhood head injuries result in more than 500,000 emergency room visits in the United States, with more than 95,000 hospitalizations. Although 90% of all childhood head injuries are minor, about 7,000 children die each year of head trauma, and an additional 29,000 develop permanent disabilities. The most common causes of childhood head injuries in the United States are motor vehicle accidents, falls, assaults, bicycle accidents and trauma related to sports. In infants younger than 1 year old, most serious head injuries are related to child abuse.
Children often bump their heads accidentally, resulting in minor bumps, bruises, or cuts in the scalp, but no damage to the brain inside. Sometimes, more serious injuries happen.
Injuries to the head can cause a concussion. Concussions are graded on a scale of I to III, depending on the severity of the symptoms. A grade I concussion is the mildest type, with confusion lasting 15 minutes or less after the head injury, while a grade III concussion, which involves any loss of consciousness (passing out), is the most severe. In most cases of concussion, X-rays or brain scans do not show any damage. Concussions do not usually cause long-term brain damage, but repeated concussions (for example, during high-risk activities such as boxing or football) can be very dangerous, putting the child at risk of serious brain damage.
Childhood head trauma is rarely more serious than a concussion. However, when it is severe, the injury usually is from a direct blow to the skull. Sometimes, the injury can be caused indirectly, such as when blood vessels stretch and tear, the brain "bounces" against the inside wall of the skull, or the brain swells as a result of chemical changes.
The most serious types of the most serious brain injury include:
After each of these serious head injuries, there can be swelling inside the brain, which increases the pressure inside the skull. Severe head injuries -- especially those caused by motor vehicle accidents and falls from high places -- also can be accompanied by damage to the neck bones or to important organs inside the body. These additional injuries often cause blood loss, breathing difficulties, very low blood pressure (hypotension), and other problems that can complicate the child's treatment and make recovery more difficult.
Head injuries cause many symptoms, depending on the type of injury, its severity and its location on the head and the brain inside. The child's neurological symptoms can include:
In addition, physical signs can include:
In most cases of mild childhood head injuries, parents call the doctor's office first to determine whether their child needs to be evaluated in person. If you contact your child's doctor about a head injury, the doctor will want to know:
Based on your answers to these questions, the doctor may decide that no further medical evaluation is necessary. If this is the case, the doctor will give you detailed instructions about symptoms to watch for at home and what to do if your child's condition changes.
If your doctor tells you to bring your child to the office or to go to an emergency room immediately, you will be asked the same questions there. Emergency room personnel also will want to know about any medications your child is taking and his or her medical history, including any prior head trauma or brain (neurological) problems, such as cerebral palsy, epilepsy or developmental disabilities. These questions will be followed by a thorough physical and neurological examination. If the results of these exams are normal, no further tests may be necessary. However, the doctor may decide to monitor your child's condition for several hours in the emergency room. After that time, the doctor may send you home with instructions about specific signs and symptoms to watch for during the next 24 to 48 hours.
If your child's history, symptoms or physical findings point to a significant head injury, then further evaluation, monitoring and treatment are needed.
How long symptoms last depends on the type and severity of the injury. For example, pain from mild head injuries usually lasts for only a few minutes. Symptoms from a concussion often go away within minutes or hours after the injury, but a child may have some confusion, memory loss, difficulty concentrating, headaches, dizziness or fatigue that lasts for several days or even longer. This collection of symptoms, called post-concussion syndrome, sometimes can last for weeks or even months. The most severe forms of head injury may require long hospital stays for rehabilitation. Rarely, they can cause death.
To help prevent head injuries in children:
Children with mild head injuries usually don't need any treatment other than careful monitoring for 48 hours. For a child with a concussion careful monitoring also is important and the child may need to stay out of sports for an extended period. If your child's injury is more serious and he or she is being monitored in the emergency room or has been admitted to the hospital for observation, medical personnel will periodically assess your child's condition. Once your doctor is satisfied that your child can be sent home safely, he or she will allow you to leave with instructions. If your child complains of headaches, your doctor probably will suggest acetaminophen (Tylenol). You should avoid giving your child aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn) or indomethacin (Indocin), because these drugs may increase the risk of bleeding inside the head.
In children with more serious head injuries, treatment depends on the type of head injury, its severity and location. In some cases, the child may need to be treated in an intensive care unit (ICU). Depending on the severity of the brain injury, treatment may include a respirator machine to breathe for your child, and medications to control pain, limit body movement, decrease swelling inside the brain, maintain blood pressure and prevent seizures. Surgery may need to be done to drain an epidural or subdural hematoma, or to treat a depressed skull fracture, brain hemorrhage or contusion.
When To Call a Professional
Call for emergency help immediately if your infant falls and does not respond to your voice or touch, or if he or she appears to have trouble moving any body part. In any other situation where a baby falls and hits his or her head, call your doctor for advice. This is the safest thing to do, even if the infant appears to have no serious injuries.
Also, call for emergency help immediately if your older child hits his or her head and is unconscious (passes out). Call your doctor immediately if your child hurts his or her head and has any of the symptoms described in the Symptoms section.
The outlook depends on the location and severity of the injury, as well as the child's age. For example, most children with mild head injuries have an excellent prognosis with a very low risk of long-term complications. However, infants may be more likely to have complications because their brains have not finished growing.
National Institute of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD 20824
National Institute of Child Health and Human Development
Building 31, Room 2A32
31 Center Drive
Bethesda, MD 20892-2425
American Academy of Neurology (AAN)
American Academy of Pediatrics (AAP)
141 Northwest Point Blvd.
Elk Grove Village, IL 60007-1098
Family Caregiver Alliance
180 Montgomery St.
San Francisco, CA 94104
National Rehabilitation Information Center (NARIC)
8201 Corporate Dr.
Landover, MD 20785
Brain Injury Association of America
1608 Spring Hill Rd.
Vienna, VA 22182
Brain Trauma Foundation
7 World Trade Center
250 Greenwich St.
New York, NY 10021
National Institute on Disability and Rehabilitation Research
400 Maryland Ave., S.W.
Washington, DC 20202-7100
National Highway Traffic Safety Administration
U.S. Department of Transportation
1200 New Jersey Ave., SE
Washington, DC 20590
U.S. Consumer Product Safety Commission (CPSC)
4330 East West Highway
Bethesda, MD 20814