Q: We all know that kids fall down a lot and hit their heads. When is the appropriate time to bring them in to be seen? What is there to look for that is serious cause for concern?
— Diana Yerena
A: Examples of minor head injuries would be falling while standing or running into a stationary object like a door or wall — with no loss of consciousness, normal activity and behavior after the injury, and no repeated vomiting or severe headache. In these circumstances, parents should call their pediatricians and observe the child at home.
In recent years, pediatric emergency medicine physicians and other professional groups suggested limiting the use of head computed tomography (CT) scans for children with more serious injuries because the risk of radiation outweighs the benefit. Recently, a large national study looked at more than 40,000 children with head injuries and recommended head CT scans in the following cases:
- Motor vehicle crashes and vehicle rollovers
- Accidents in which pedestrians or bicyclists not wearing a helmet are struck by a motor vehicle
- Falls of greater than three feet for children younger than 2 years and greater than five feet for children 2 or older
- Accidents in which children get struck in the head by high-impact objects like baseball bats
Medical attention should also be sought for children who suffer a head injury and then:
- Exhibit a change in behavior (like increased sleep or irritability), develop a severe headache, or vomit repeatedly
- Lose consciousness, develop bruising around the ears or nose, or start bleeding from the nose or ear — any of which may indicate a skull fracture
Children at the greatest risk after a fall are infants and children younger than age 2; children with a bleeding disorder such as hemophilia; children with any history of brain surgery (shunt); and children on a blood thinning medication. An emergency department should evaluate any of these children after any type of head injury because they are at higher risk for bleeding inside the skull.
– Mohamed Badawy, M.D., medical director of Children’s Emergency Department and assistant professor of Pediatric Emergency Medicine at UT Southwestern
– Halim Hennes, M.D., division director of Pediatric Emergency Medicine at Children’s and professor of Pediatric Emergency Medicine at UT Southwestern
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