Head Injury: When It’s More Than a Bonk on the Head
Feb 18, 2022
Most parents can agree, children seem prone to head injuries. Toddlers, with their big heads and poor balance, smack into furniture while running or bump their heads on the ground when falling. As children grow up and start playing sports, concussions become one of the most common sports-related injuries.
Following an Injury, What Should Parents Do to Monitor Their Children?
After a head injury, children should be watched carefully for 24 hours for any concerning symptoms (see below). The scalp has a lot of blood vessels, so any cut to the scalp can lead to serious blood loss. Apply pressure to stop the bleeding. While head injuries can be scary and overwhelming, don’t forget to check for injuries to other parts of the body (especially the neck). Minor injuries may be watched at home, but if there are any concerns, seek medical attention immediately.
Head Injuries Will Happen, so What Are Some of the Danger Signs That Parents Should Watch for After an Injury?
Drowsiness, child is more difficult to awaken
A headache that gets worse or won’t go away (in babies, baby is crying and won’t stop)
Concussion: A concussion is a brain injury that causes a temporary change to the way the brain functions, but we see no damage to the brain on imaging. For example, after a head injury that causes concussion, a child might have a few minutes of appearing confused. If you were to scan the patient’s head, you would see no brain abnormality.
Intracranial hematoma: This is a fancy way of saying that there is blood somewhere inside the skull. That blood could be outside the covering of the brain, under the covering of the brain, or in the brain itself. A scan would show a brain abnormality.
What Are the Treatments for Head Injury?
For patients with concussion or mild brain injury, the clinician may decide to release the patient to home and not obtain imaging. All patients with brain injury (even mild concussion) need clearance for return to school and activities. This type of care can be provided by a primary care physician or by a concussion clinic.
For more serious cases, head CT is often used to check for internal bleeding. If the brain injury caused bleeding, the patient will likely be admitted. If the injury is severe, the patient may need a temporary device to measure brain pressure.
It is uncommon for brain injury to require surgery, but surgery may be done to stop the bleeding and remove any blood, if the injury is putting pressure on the brain. Other reasons to operate are to repair a skull fracture or wash out an injury that is at risk of infection.
Since brain injury can cause seizure, many moderate and severe brain injury patients are temporarily put on medications to prevent seizure.
There are no medications that we can give to treat a brain injury, so prevention is the best approach. Families should encourage wearing seatbelts while in a car, wearing an appropriate helmet for any activities, and avoiding risky decisions/behavior.
Eric A. Sribnick, MD, PhD, is a pediatric neurosurgeon at Nationwide
Children’s and principal investigator in the Center for Pediatric Trauma
Research. He is also assistant professor of neurological surgery at The
Ohio State University College of Medicine.
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