The serene moments of childhood are measured by toothless grins, tottering first steps, height-hashmarks on door jams, and sticky-fingered hugs. However, these moments are interspersed with the not-so-fun hallmarks of childhood—coughs, colds, cuts, scrapes and on occasion, more serious and frightening incidents such as head injuries.
The Brain Injury Association of America reports that annually an average of 62,000 children, ages 0-19, sustain brain injuries requiring hospitalization as a result of motor vehicle crashes, falls, sports injuries, physical abuse and other causes. More than 560,000 children each year are seen in hospital emergency departments for brain injury and released.
Head injuries in children vary widely in mechanism and severity, says Johns Hopkins All Children’s Hospital neurosurgeon Jerry Tuite, M.D. “Most children suffer head injury as a result of a blow to the head, but the brain can also be affected by aggressive shaking or rapid whiplash type movements of the head that result in sudden acceleration or deceleration,” he says.
Head injuries are broadly classified as:
- Mild—not associated with a loss of consciousness or a diminished level alertness, but they may result in temporary confusion, disorientation or even temporary vomiting.
- Moderate—typically associated with a loss of consciousness, with a longer period of confusion, disorientation and vomiting, and possibly even a brief seizure, with a recovery period of more than hours or a day or so.
- Severe—the most dangerous type, typically associated with a prolonged period of unconsciousness, with persistent or worsening lethargy, unresponsiveness, multiple seizures and a variety of neurological signs, commonly asymmetric pupils or unequal or abnormal movements of the extremities.
Parents, take heart. Though it is impossible to prevent all childhood injuries, there are steps you can take to decrease the likelihood of serious injury. Tuite advises, “Close and careful supervision of babies and young children are necessary, and the routine use of seat belts is imperative when riding in any vehicle. Even though children may be reluctant to do so, helmets should be used when head injury is more likely, such as when riding bicycles, skateboarding or skiing.”
And if a head injury does occur, step one is to remain calm and evaluate the injury looking for obvious signs such as cuts or bleeding. “If there is any prolonged loss of consciousness, serious cuts or abrasions, or neurological symptoms such as pupillary asymmetry or weakness, call EMS for immediate medical attention. Even if a child recovers quickly, if there is a definite loss of consciousness or if the mechanism of injury was severe, a medical evaluation should be performed the same day,” Tuite says. “For mild injuries like a simple fall with no loss of consciousness, close observation is generally adequate. However, if there is any concern, such as serious vomiting, sleepiness, neurologic problems or anything worrisome, don’t hesitate to seek a medical evaluation in the emergency department.”