Children keep growing and their brain is still developing. So, injuries sustained by their little brain may have lasting effects.
Introduction
No age group is exempt from head injuries. However, the cause of head injury varies among age groups and from one region to another. For example, in India, fall from height is common. Whereas in the West, child abuse is the common cause of head injury in children.
Common Causes
Few common causes of head injury among children include:
- Fall
From balcony, cot, or while the child learns to walk or is engaged in play.
- Road Traffic Accident
Among children, road accidents are more common on the way to school and back.
- Injury During Birth
Injuries can happen to the baby’s head when instruments are used to pull th ebaby out of the birth canal or if the baby’s soft skull presses agains the mother’s pelvic bones, while pushing its way out.
- Child Abuse
Shaking a child vigorously results in injury to the nerves and blood vessels in the brain, sometime cause tiny bleeds in the brain.
Type of Head Injuries
Even through the injuries in children are the same as that in adults, children present with unique features. The clinicial picture and management are different too. Following are few types of injuries sustained by the pediatric age group:
- Scalp Injury
In infants, injury to the scalp is usually sustained during birth, as the child passes through the birth canal. In other age groups, scalp injury is very common during the child’s playtime, mainly due of falls.
- Fracture
Fractures are uncommon in children because children’s skull are softer than adults and can mold easily. But when the injury is too severe, two types of fractures may result. Linear or a straight line fracture and depressed fracture, where a small part of the skull gets distorted or deformed, as it tries to mold itself.
- Hematomas
A bleed in the brain is known as hematoma. This can occur when a vein or artery is damaged, as a result of head trauma. The bleed can occur above (extradural) or below (subdural) the dura mater (a touch sheath covering the brain), or within the brain (intra cerebral).
- Contusion
A bruise on the surface of the brain is known as contusion. When the head goes through a violent movement, the forces cause the brain to move within its enclosure and strike or squeeze itself against the outer covering protecting it. This bruises the brain. Children don’t show symptoms immediately after a contusion. So a careful observation for a delayed deorientation is required.
- Diffused Brain Swelling
This condition is 2-5 times more common in children than in adults as a child’s brain is so delicate. This usually happens when any head injury initiates fluid accumulation in the brain and hence brain swelling. Even a mild head injury might result in diffuse brain swelling. A CT scan should be performed to recognize the condition early, for immediate intervention.
- Diffuse Axonal Injury
Diffuse means ‘scattered’. Axon is the part of a brain cell that is involved in transferring information within the brain. During a fall or a traffic accident where the child is knocked down by the vehicle, brain shakes vigorously, causing damage to the axons. The injury is scattered across the brain, hence the term ‘diffuse axonal injury’. This often occurs together with a concussion.
Complications due to Pediatric Head Injuries
Disseminated Intravascular Coagulation (Disseminated: widespread, intra: inside, vascular: blood vessel, coagulation: Clotting of blood) is a common complication arising out of head injuries.
The brain tissue is a rich source of thromboplastin, a protein that helps in the clotting of blood. When the brain is injured there is an outpouring of thromboplastin from the brain into the blood. This causes a widespread clotting cascade throughout the body. Small vessels get blocked because of random clots obstructing the flow of blood. This compromises blood supply to various regions.
However in time, all the proteins that help with the clotting process is consumed and deficiency results. When there is deficiency, the opposite happens. There is random bleeding from different sites. Bleeding may be so profuse that it becomes difficult to control. If it is not treated early, this lead death of the child.
To prevent this, all children who sustained severe head injury must be monitored closely and their blood parameters should be measured regularly.
Symptoms
Common symptoms after a head injury are:
- Vomiting
- Nausea
- Headache
- Vision problems
- Fits
- Loss of consciousness
- Irritability
- Restlessness
- Agitation
- Low heart rate
- Weakness of one or more parts of the body
- Difficulty concentrating
Not all symptoms are seen in every child with a head injury. Depending on the type and severity of the condition, symptoms vary.
Some minor traumas don’t present with any symptom. Children return to their play immediately after the hit, but come back with complications later. So, apart from symptoms, further diagnostic investigations are required to evaluate the child and provide appropriate management.
Investigations
Here are the standard tools used for diagnosing a head injury in a child and possibly its effects:
- X-Ray
This is an useful diagnostic tool that shows skull fractures clearly at a Glance. A swelling resulting from head injury can also be appreciated easily appreciated.
- CT Scan
To get a detailed view of the brain, a CT scan is required. Minor fractures missed by an X ray can be spotted by a CT scan. Bleeding or changes in brain structure can also be identified using this imaging modality.
- MRI Imaging
To get a clearer view of blood vessels and exact location of a bleed, an MRI image is required. Since brain is a soft tissue, minor changes in brain structure can also be easily picked up in an MRI.
Treatment for Pediatric Head Injuries
Treatment to Pediatric Head Injury depends on its type and severity. Minor concussions and contusions can be left untreated and injuries that don’t show up on imaging and don’t produce symptoms can be left without a treatment. As a child’s brain is growing, minor injuries heal on their own in the course of time.
Hematomas that are seen at birth also heal on their own in two weeks. However, large hematomas, fluid accumulation in the brain, brain swelling and expanding fractures need to be addressed immediately.
Medical Treatment
Most of the medical treatment for Pediatric Head Injuries are administered for moving the fluid accumulation from the brain. Nerve protecting medication and drugs that prevent seizures are also given.
Surgical Treatment
Surgical treatment for pediatric head injuries fall in to the following categories:
- Evacuation of Hematoma: A small hole is drilled into the skull and the accumulated blood is removed.
- Shunt Placement: When there is brain swelling because of fluid accumulation, a metallic tube is placed in the brain that sucks excess fluid from the brain and directs it to any other space in the body that can absorb the incoming fluid. This relieves the pressure inside the brain and prevents further damage.
Go here for more information on surgical treatment for the ailment.
Treatment Window
Recovery of the child with head injury depends on the child’s age at the time of injury, severity of the injury and its location. Early identification of the injury and initiation of appropriate treatment helps to save the child’s brain.