It’s a fact of life: Kids hit their heads.
From toddlers just taking their first steps to teenagers getting in car accidents, the world is full of scenarios that can lead to head injuries.
In the United States, there are approximately 600,000 emergency room visits every year for head injuries. These include minor problems such as scrapes and bumps to more serious injuries such as concussions or brain injuries. Fortunately, 99 percent of the time the injury is of the minor variety and causes no further concerns.
The difficult issue for many parents is determining whether an injury is mild or whether it is more severe. Though there are no absolute answers, a large nationwide study conducted in 2009 offers guidelines to help differentiate mild injuries from more severe brain injuries. Because verbal-aged children can often tell a doctor how they are feeling, the guidelines have been split into two groups based on age.
For children under 2 years old, worrisome symptoms would be loss of consciousness, falls from two feet or greater, altered behavior, and/or a large bump to the head located anywhere except the forehead.
For those older than 2 years old, the guidelines include loss of consciousness, falls from a significant height, vomiting, change in behavior and severe headache.
Other concerning symptoms include seizures or bleeding from the ears. If your child’s injury displays any of these characteristics, they may have a more serious problem and you should either see your doctor or take them to the emergency room for further evaluation.
During the medical evaluation, a physician will likely ask you about any worrisome symptoms and examine your child to look for other concerning signs. If your child looks well and you agree that they are improving, it is possible the physician will discharge you home after a small period of observation. On the other hand, if the symptoms are not improving or have worsened, you may be asked to stay longer for observation or have other tests done.
One test that may be considered is the computed tomography scan (CT) or “CAT scan.” This test is a type of X-ray that can look for fractures of the skull or bleeding in or around the brain. It is a quick, painless test that allows a physician to determine if any life-threatening injuries exist. Since it is such an easy test to do, many parents wonder why it is not ordered on every patient with even a mild bump to the head. The reason is radiation. New evidence suggests that the radiation from a CT scan can damage cellular DNA, so it is prudent to use CT scans only when indicated by the guidelines above or if there is other worry for brain injury.
If there are no concerning findings on the CT scan, you will likely be discharged home. You will be asked to observe your child for the next 24 hours.
Another diagnosis many have heard of is concussion. These are the types of injuries that are common in football and other high-impact sports. Essentially, it means that the brain was shaken up inside the skull and that the patient may have had some confusion or memory loss after the event. It does not mean there is bleeding in or around the brain and there is no test in the emergency room that confirms the diagnosis.