All you need to know about head injuries

Head injuries are common in children and studies have shown that roughly 500 000 children land up in the ER due to some kind of head injury annually. Accidents do unfortunately happen, especially when babies start walking or children take part in physical activities.

I am an avid supporter of physical activity for children. It is a vital part of physical development and overall well-being, but care must be taken to protect a child’s head. Heads bleed profusely and the sound of a head being thumped is not for the faint-hearted, so let’s take a look at this topic in more detail, as well as prevention and treatment.

Common causes of head injuries

• Falls
• Motor vehicle accidents where the child is a passenger or is struck by a car.
• Sport injuries
• Child abuse

Classification of head injuries

• Internal injuries which could involve the brain, blood vessels or skull.
• External head injury which would involve the scalp.

Immediate steps to take:

In order to get the best care for your child, it is necessary to assess the situation and decide on the seriousness of the injury. If it is a knock to the head, then a cold compress should be applied to the head while you assess the situation. A packet of frozen peas or vegetables wrapped in a towel is a great cold compress. If it is an open cut, then wash the area with mild soapy water. Use a clean cloth to apply pressure for about 10 minutes to stop bleeding. Apply a cold compress for 20 minutes to reduce pain and swelling.

Assessing the seriousness

• Mild injury is where the child has a light injury on the head resulting in a bump or bruise. The child is alert and there is no change in behaviour.
• Moderate to severe – I would recommend that if your child experiences any of these symptoms, that you seek medical help:

1. Loses consciousness
2. Is drowsy or confused
3. Does not cry immediately after being struck on the head
4. Vomits
5. Has weakness in their arms or legs
6. If the pupils of the eyes look different or the vision is affected
7. Red or tired eyes
8. If there is an object stuck in their head or if there is severe bleeding
9. Has a seizure (convulsion or fit)
10. Clear fluid draining from the nose or ears.
11. Deep, open wound on the scalp

Common types of head injuries

• This injury may be mild to moderate. It is usually temporary but is associated with symptoms like dizziness, confusion, vomiting, headaches and visual disturbances. A concussion can last for up to four weeks, with the most difficult time being the first 48 hours. Normal physical activity should not resume for about four weeks and the child should get plenty of rest and sleep.

If you are interested, have a look at this YouTube video on concussion:

• Contusion. This is really a bruise to the brain as a result of being struck on the head. A bleed and swelling occurs inside the brain in the area of the injury.
• Skull fracture is where the skull bone actually breaks. There are various kinds of fractures depending on the type of injury.

A depressed skull fracture usually occurs as a result of being hit on the head with an object like a cricket bat. You would actually be able to feel the dent in the skull from the injury.

A linear fracture occurs along the sutures of the skull but doesn’t shift the bones.

The most dangerous is a basilar fracture, which is a break in the bone at the base of the skull. Children with this kind of injury may have clear fluid running out of their nose or ears and are likely to develop bruising around their eyes or behind their ears. Urgent medical attention is required.

“Studies show that most head injuries are preventable and predictable.”

• Bruising or internal damage to the brain. This kind of injury is often associated with motor vehicle accidents. The brain jolts backwards and can hit the side of the skull resulting in bruising. The jarring of the brain may also cause the internal lining or blood vessels to tear and this will result in bleeding and swelling of the brain. A direct blow to the head or shaking a child may also cause this type of injury. This type of injury would require urgent medical attention.

Preventing head injuries

Studies show that most head injuries are preventable and predictable. This is a scary thought when we acknowledge that head injuries are the major cause of death in young children. Here are some important points to remember:

• Always secure your child in a car seat, a booster or with a seat belt.
• A child should wear a helmet when riding a bicycle, skateboarding, horse riding, skiing, or playing a sport involving a bat.
• Use safety gates at the top and bottom of stairs.
• Use non-slip mats in the shower or bath.
• Remove tripping hazards like wires or loose rugs.
• Ensure the playground has a shock absorbing surface. This can be a product such as rubber or mulch.

Structure of the skull in newborn babies

It is important to remember that a newborn baby’s head is not just a small version of a child or adult’s head.

A newborn baby’s head is made up of soft bony plates that can be compressed and often overlap one another during a vaginal delivery. The bones are held together by sutures. These act like expansion joints, allowing the plates to overlap during birth, but also allowing for the skull to expand during the first year of life when the baby’s brain grows rapidly in size.

When you run your hand over a baby’s head you will feel two areas where there is a space between the bones. These are known as fontanelles. The fontanelles are covered by a strong membrane that protects the brain:

• The anterior fontanelle (also known as the soft spot) is on top of the head and this stays soft until the baby is between 18 months and two years old.
• The posterior fontanelle found towards the back of the head is much smaller. It closes during the first few months of life. Since a baby’s head is shifting and delicate, care needs to be taken to protect your baby. Normal handling will not injure your baby’s head.
• Diastatic fractures are most common in newborns or older infants because of the structure. Here, a break in the skull occurs along the suture lines and causes these lines to widen. This kind of fracture occurs if a baby is dropped, falls from an elevated surface or is handled roughly.

Preventing head injuries in babies

• Ensure that you have a good car seat to protect the head.
• Never leave a baby unattended on an elevated surface like a change table or bed.
• A baby must be strapped into a high chair or pram.
• Walking rings are a major cause of head injuries as they tip easily and babies do not have sufficient reflexes to protect themselves in a fall. The American Paediatric Association is working to have walkers banned because of the high number of injuries sustained to babies when using walkers.
• Ensure that windows and staircases are covered by grids.
• Put your baby on the floor, into a playpenn or in a crib if you do leave the room.
• Ensure all furnishings such as bookcases and TV stands are fastened to the wall. Babies may try to pull themselves to standing on furniture and if not secure, may topple over.

There is no doubt that every parent will have the dreadful experience of their child bashing their head. Even when it is a mild injury the bumps and bruises are disturbing. Since head injuries can have dire consequences, I would advise parents to take care in securing their homes, insisting on helmets when appropriate and making sure they recognise the signs and symptoms of more serious head injuries.

If you are at all unsure, contact your healthcare professional or take your child to the emergency room. In my experience, the caregivers are often as traumatised as the child so an objective opinion leads to better decision making when dealing with a head injury.

This article was first published on BabyYumYum.