Head injuries in children

Trauma remains the most common cause of preventable death in childhood, with head injuries being the most common cause.

Dr Donovan Dwyer, Director of Trauma at Sydney Children’s Hospital, Randwick says many head injuries are preventable. Parents can reduce the risk of their child sustaining a head injury by supervision, good role modelling as a pedestrian in traffic, and always wearing a helmet on bicycles, skateboards, scooters and certain sports.

Despite taking these preventative measures, some head injuries will still occur.

“Children can't be kept in cotton-wool and exploring toddlers, traffic unaware primary school children, impact sport partakers and risk taking teenagers, will often sustain head injuries despite our best efforts,” Dr Dwyer says.

This was the case with three-year-old SCH patient Mina, who suffered a severe head injury after falling from a very low kitchen stool.

At first Mina showed no sign of injury. Her mum Marion says Mina kept rubbing the side of her head, but there was no lump or bruise. When Marion put Mina to bed that night, the toddler vomited and Marion suspected concussion. She took her daughter to the Emergency Department where Mina was diagnosed with an extradural haemorrhage and underwent surgery. After spending time in ICU and further surgery, Mina has recovered well.

“Mostly children will have external evidence of a head injury, but it is not uncommon to have intracranial injuries without obvious external evidence of injury, such as the case with Mina,” says Dr Dwyer.

Children that are seen in emergency departments following an injury to the head, are risk assessed dependent on their age, the mechanism by which they injured themselves, their initial and ongoing behaviour, and their examination findings.

For parents, concerning features to watch out for include:

  • evidence of a swelling on the scalp
  • short lived seizures or loss of consciousness
  • behavioural changes including:
    • drowsiness
    • increasing headache
    • vomiting
    • unsteadiness
    • dizziness
    • short-term memory loss
    • confusion

“A child with any of these features or other concerns, should seek medical attention to enable a doctor to perform a risk assessment and decide on further management.

“In general most children observed for a period of 4-6 hours with improvement to the point of normal behaviour as assessed by the doctor, and the parents who know the child, are very low risk for developing any significant intracranial complication of the head injury. These children, however, will still be discharged with head injury advice detailing the symptoms that should prompt return to the emergency department.

“Never feel your concern for your head injured child is wasting anyone's time, doctors are trained and willing to assess head injured children. But – remember that prevention is best.”