Head Injury

It is a good thing that kids are so headstrong, and even more important is that kids’ heads are strong. All kids will bump their noggins at some point, and no matter how small of a bump, it always looks dramatic. The vast majority of the time, little Johnny or Jane will get a good-sized bump and not much more. The next day sometimes the bumps on the noggins are bigger than the day of the incident, or sometimes if the bump is near the eyebrows, you can get bruising starting to form around the eye. But again, as long as kiddo is otherwise acting like themselves, we can just let them be. You can try to put an ice pack on the swelling, but this is often a battle that you will not win with a little kiddo who does not want to sit for more than 2 seconds with an ice pack on their boo-boo.

 But what should we be looking for if the bump on the head is more serious? Whenever a kiddo falls or bumps their head, it will hurt, and they should cry immediately and look to you for help and comfort. If the fall or head injury causes a loss of consciousness, that is an immediate go to the emergency room for a CT scan of the head. Otherwise, we should just watch the kiddo for the day and make sure they are acting like themselves for the most part. Sometimes I have families saying they are constantly looking at their child’s pupils after they fell, but in actuality, the change in pupils or nonreactive pupils is a rather late finding in kids with intracranial (head) injury. Little Johnny or Janie would be showing a lot of other signs that they were not well before a blown pupil. Just watch to make sure they are playing well, eating and drinking well, etc. If they are acting wobbly all day or starting to vomit, we should see them either in clinic or the emergency room. If a kiddo falls from twice their height or more, that can also lead to more serious injury and should be evaluated by a pediatrician in clinic or the emergency room. 

Let’s say your kiddo does fall from a height above twice their own height or is just not acting right, and you take them to the emergency room. The doctors there will decide if we need to run a CT scan or not to look for bleeding in the noggin. There is a set of rules called the PECARN rules that help us decide who should get a CT scan and who should not get a CT scan and just be observed for a bit. The rules are as follows:

Medical term translations: AMS (altered mental status), fx (fracture), GCS (Glasgow Coma scale - lower number is worse), hematoma (blood collection in tissues), LOC (loss of consciousness)

Now why all the rules and criteria? Can’t we just do a CT on everyone? Well, I guess yeah, but a CT scan is like doing hundreds if not thousands of X-rays all at once to a kiddo’s noggin. Pediatricians are very conscientious of this and prefer to use this form of imaging only in emergency situations where there is a high likelihood that something bad is going on and worth the radiation dose.