“I’m glad it wasn’t worse, but it could have been. Thankfully, we trusted our instincts to take him to the hospital.”
Always better to be safe than sorry following head injury
There’s a lot of truth to these classic nursery rhyme words. Especially during our early years when we’re just starting to explore our world.
Head injuries, often the result of a fall, are among the most common reasons for a child to visit the emergency room. In fact, children aged 0 to 4 are the population most likely to come in for head injury, with ages 15 to 24 a distant second.
“On any given shift I’ll see, on average, five head injuries,” explains Alexander Materna, MD, pediatric emergency physician. “Typically kids fall and hit their head on a table, wall or floor, or sometimes it is a fall from height, like baby chairs, a parent’s arms, or a shopping cart.”
Seven-year-old Matthew, of Hamilton, knows this all too well. During a quick shopping trip with his parents, Matthew experienced a fall from a few feet off the ground in which his head hit a hard floor with force.
“Within just a short period of time, he said he needed a nap. He was irritable. He had a headache. None of this was normal for him,” explains Matthew’s mother, Liz.
Determining Diagnosis
Like any child, Matthew had experienced bumps on the head before, but considering the type of impact and his reaction to the injury, his parents decided it was best to take him straight to the hospital.
“An hour or so after his fall, Matthew was still fussy. According to his parents, this was out of character for him so we knew it likely was more than a simple bump,” explains Dr. Materna.
One of the keys to determining Matthew’s diagnosis was the information Dr. Materna received from his parents. Knowing the child and what would be their “normal” can be just as important to diagnosis as the symptoms themselves.
“Fussiness beyond how a child would normally behave, and over a long period of time can be a tell-tale sign there might be a brain injury,” explains Dr. Materna. “We rely on the parents or caregivers to help with that information so that we can determine the appropriate testing and find out the extent of the injury.”
A CT scan of his head revealed Matthew had experienced a subdural hemorrhage. This occurs when there is bleeding in the space between the layers of tissue surrounding the brain. The result: the potential space between the layers fills with blood and expands.
“This type of injury can be dangerous because the buildup of fluid can cause a shift in the brain, or a midline shift. This can lead to a herniation that can be life threatening if not treated in time,” explains Dr. Materna.
Matthew was transferred to the Bristol-Myers Squibb Children’s Hospital in New Brunswick for further evaluation. There, Matthew stayed overnight, with access to pediatric specialists only available in a Children's Hospital setting.
Fortunately for Matthew, the injury simply required an overnight stay at the hospital. Matthew needed observation to make sure his bleed didn’t get larger. This included mental health status checks using the Glasgow Coma Scale, which evaluates various points of motor function, including eye opening, motor and verbal response.
“Sometimes to relieve the pressure on the brain from a subdural hemorrhage, surgery is required,” Dr. Materna explains.
Common approaches for this type of injury may be a burr hole or craniotomy to evacuate the blood.
Upon his release, Matthew’s parents were asked to watch for abnormal activity, vomiting, not moving extremities. To avoid secondary injury, Matthew was told to sit out of recess and sports for two weeks.
“Aside from a bit of a black eye that developed a couple days later, he had returned to his normal self,” explains Liz. “I’m glad it wasn’t worse, but it could have been. Thankfully, we trusted our instincts to take him to the hospital.”
Beyond the ‘Bump’
“If your child has experienced a fall and you’re not sure if it’s serious, call your pediatrician. Let them know what’s going on, and get their advice,” recommends Dr. Materna.
There are several things to look for in a child who has had a head injury that, if applicable, will be helpful information for your pediatrician. Some common symptoms related to serious head injury include:
- Headache
- Sensitivity to light and sound
- Dizziness
- Vomiting
- Unsteady gait (walking)
- Seizures
- Inability to move an arm or leg
- Not acting like themselves
In the event your pediatrician suggests going to the hospital, evaluation and testing will be performed by the hospital staff. However, Dr. Materna explains it’s important to recognize that every head injury does not warrant a CT scan.
“The radiation exposure in one CT scan is more than 60 times that of an x-ray. Overexposure can have a range of effects from increased risk of cancer to decreased school performance. Unless serious injury is suspected, it’s important to keep this type of testing at a minimum in young children,” Dr. Materna says.