This week’s guest columnist is Dr. Leslie Birdsong, a family practice resident at the University Health Center here in Lafayette.
You are downstairs doing a million things. Your kids are upstairs playing, making sounds like herding elephants. Suddenly you hear a louder crash. You strain to listen, and have that stab of anxiety: what sound is next? Laughter and more elephants, or gut-wrenching silence? You yell up the stairs, “Is everybody ok?” More silence. Now you are truly frightened and bound up the stairs .
Every parent fears their child having a head injury. Head injuries make up many hospital visits for kids. Here are some numbers: In kids less than 14 years, yearly there are over 500,000 Emergency Department visits for head injuries. 37,000 of those kids get admitted to the hospital for observation, or surgery. So when do you need to bring your child to the hospital? Here are some rules.
We divide head injuries into two groups: those younger than two years old, and those two and older. This is because younger children react differently to head injuries. They are more difficult to assess because they can’t tell us what’s wrong. Also, infants may not show many outward signs of injury.
In kids less than two, here are the rules. 1. Is the child walking, talking, and acting well for their age when we see them in the ED? 2. Is the child acting like themselves for mom and dad? You are with your child a whole lot more than the 10 minutes we get. Tell us if your kid is acting “funny.” 3. Are there big lumps on the scalp? Swelling and bruises on the forehead are okay, but swelling on other parts of the skull needs checking. 4. Did the child lose consciousness? Any child that gets knocked out should be seen. 5. Was the injury mechanism severe? If a child falls over from standing and hits her head- no big deal. But a fall on the head from greater than three feet could be trouble. A fender-bender car crash doesn’t require an evaluation, but if the car rolled over the kids need to be checked. Impacts from baseball bats and golf clubs- bring ‘em in!
For little kids, the common and scary scenario is usually like above- the parent hears boom and then silence. For older kids it is the call from the school or worse, from the police- your child has had an accident. Still, most older kids have mild head injuries they easily shake off. The rules to assess children older than two are a little different than the ones for the babies and toddlers from above.
1. Is the child awake, alert, and acting normally? 2. Was the kid knocked out? 3. Is the child vomiting? Note that vomiting is NOT on the list for kids under two years- they can vomit just from crying really hard or gagging on mucus. But if kids over two are vomiting because of a head injury- that worries us. 4. Does the child have a bad headache? The littler kids can’t tell us about this but the older kids can, and that counts. 5. Was the mechanism of injury severe? This means falls onto the head from greater than 5 feet, a car roll-over, or an impact from a thrown baseball or swung bat.
When a kid meets any of these criteria, they may need a CT scan of the brain. CT scan helps find bad things like bleeding in the brain or skull fractures. So why don’t we just scan every kid and be sure? No, it’s not about the money. CT scan uses lots of radiation, up to 500 times the radiation of a regular x-ray. Our physician motto “Do No Harm” comes into play. The benefit of seeing into the skull needs to outweigh the risk of future cancers.
What is the bottom line here? If your child falls down and goes boom and has any of the signs we listed, get him seen. If you are unsure if any of the rules above are positive, call your doctor. But if you have good answers for all the rules, then all baby needs after falling and going boom is a hug and a kiss on the noggin.