Head injury symptoms in Children and Management

Why head knowing the Head injury in children is important

Children are very active and they have no knowledge about the accidents which they will face while playing and doing dangerous activities. Every mother, father and caregiver of children should have a better knowledge about head injury. Sometimes children climb on chairs or tables and fell causing head injury. Even falling from bed can cause serious head injury to a neonate.

A head injury can be as mild as a bump, bruise(contusion), or cut on the head. Sometimes it can be a deep cut or open wound, broken skull bones, internal bleeding, or damage to the brain.Head injuries are one of the most common causes of disability and death in children.

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What shall you do if your child get a head injury

It depends on the mechanism of the impact. If your child is alert and playing, that is ok. But keep eyes open about the child behaviour, It’s better to seek advice from your family physician regarding your child.

What are the criteria for performing a head scan in children with a head injury according to the NICE guideline

For children who have sustained a head injury and have any of the following risk factors, perform a CT head scan within 1 hour of the risk factor being identified:

  • Suspicion of non-accidental injury
  • Post-traumatic seizure but no history of epilepsy
  • On initial emergency department assessment, GCS less than 14, or for children under 1 year GCS (paediatric) less than 15
  • At 2 hours after the injury, GCS less than 15
  • Suspected open or depressed skull fracture or tense fontanelle
  • Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign)
  • Focal neurological deficit
  • For children under 1 year, presence of bruise, swelling or laceration of more than 5 cm on the head

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For children who have sustained a head injury and have more than one of the following risk factors (and none of those recommended above), perform a CT head scan within 1 hour of the risk factors being identified:

  • Loss of consciousness lasting more than 5 minutes (witnessed)
  • Abnormal drowsiness
  • Three or more discrete episodes of vomiting
  • Dangerous mechanism of injury (high-speed road traffic accident either as pedestrian, cyclist or vehicle occupant, fall from a height of greater than 3 metres, high-speed injury from a projectile or other object)
  • Amnesia (antegrade or retrograde) lasting more than 5 minutes

Children who have sustained a head injury and have only 1 of these risk factors (and none of those in the first recommendation) should be observed for a minimum of 4 hours after the head injury. If during observation any of the risk factors below are identified, perform a CT head scan within 1 hour:

  • GCS less than 15
  • Further vomiting
  • A further episode of abnormal drowsiness

If none of these risk factors occur during observation, use clinical judgement to determine whether a longer period of observation is needed.

When a CT scan is performed a provisional written radiology report should be made available within 1 hour of the scan being performed.

The NICE guidance on the assessment and early management of head injury can be read in full here:
https://www.nice.org.uk/guidance/cg176

 

 

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