Head/brain injury

What is a head injury, exactly?

A head injury is any kind of trauma involving the scalp, skull or brain. Fortunately, the skull and brain covering are both formidable sources of protection, meaning that not all head injuries will have an effect on the brain.

Types

What are the different types of head and brain injuries?

Head injuries

• Scalp injuries: cuts, scrapes and bumps

Nearly every child will experience some type of scalp injury in her life—whether it’s from tripping and falling, being struck with an object, bumping into something or otherwise “whacking” her head.

Because the scalp has so many blood vessels, even a small cut might bleed profusely, and even the mildest impact might produce a scary-looking bump. Thankfully, the vast majority of these injuries are just surface wounds, and will heal within a matter of days.

However, you should always seek immediate medical attention if your child loses consciousness (even momentarily), vomits or exhibits changes in behavior after a cut, scrape or bump on the head. Learn more in our “Signs and Symptoms” section below.

• Skull fractures are breaks in any of the bones of the skull. The four major types of skull fractures are:
  
  • linear fractures, by far the most common type (accounting for nearly 70 percent of all skull fractures). In a linear fracture, the bone sustains a break, but is not moved or jarred out of place. Kids with linear fractures usually need only a brief period of observation in the hospital before resuming their normal activities.
     
  • depressed skull fractures often (but not always) occur alongside a cut in the scalp. They get their name because a part of the skull actually sinks inward, or becomes “depressed.” Surgery is typically necessary to repair the fracture.
     
  • diastatic skull fractures are breaks along the bony joints, or sutures, of the skull. Because the skull is still soft and malleable in babies, diastatic fractures are most common in newborns and infants. These breaks cause the suture lines to widen, and are usually treated with surgery.
     
  • basilar skull fractures are the most serious type. These fractures occur at the base of the skull, and frequently cause bruising around the eyes or behind the ears. If part of the brain covering, or dura, is torn, a child with a basilar skull fracture may also have clear fluid draining from his nose or ears. Close observation and intensive medical care is required.

Brain injuries

• Hemorrhages are episodes of bleeding in the brain due to some kind of trauma. They may also be referred to as hematomas. The three main types are categorized by where in the brain they occur:
  
  • subarachnoid involves bleeding between the protective tissues covering the brain and the brain itself. These hemorrhages often occur in car accidents, and but rarely require surgical intervention to stop them.
     
  • epidural describes bleeding between the cranium (outer skull) and the tough outer covering of the brain (called the dura). This type of hemorrhage can be dangerous because it tends to progress silently, not causing any visible symptoms for a period of time (lucent interval) after the actual trauma, but then can lead to severe consequences 1-2 hours later.
    
    For this reason, prompt medical attention is a must after serious blows to the head, especially if they lead to a loss of consciousness ... even if the child appears to be better for a short time.
     
  • subdural means bleeding between the hard outer lining of the brain (the dura) and the brain itself. This type of hemorrhage typically happens after a powerful blow to the head, such as a fall from a great height, and often accompanies loss of consciousness.
    
    Subdural hemorrhages require immediate, intensive treatment—sometimes including emergency surgery.
     
• Traumatic brain injuries (TBIs) are any type of brain injury caused by sudden trauma. Like other head injuries, TBIs can be mild, moderate, or severe, even life-threatening. Specific types include:
  
  • contusions, also called cerebral contusions, which are bruised and swollen areas in the tissue of the brain. They can be caused by virtually any type of head trauma, and can range in seriousness from very mild—needing only a short period of observation by a doctor—to severe, requiring surgery.
     
  • concussions, which are injuries that happen when the brain is sent into a sudden spinning motion, either because of a direct blow to the head or because of a blow to the torso that snaps the head forward or backward. Learn more about concussions.
     
  • penetrating brain injuries, which occur when the hard outer lining (dura) of the brain is pierced—either by a projectile, such as a bullet or knife, or by fragments of the skull that are forced into the brain by a violent impact (for example, in a car accident). Penetrating brain injuries can be life-threatening and require immediate emergency care.
     
  • diffuse axonal injuries, which happen when the head is forced forward or backward at a rapid speed, shearing the brain’s white matter (which facilitates messages throughout the central nervous system).
    
    These injuries are particularly devastating because they cause widespread neurological damage, and may lead to coma or death. Children with less severe diffuse axonal injuries may benefit from medication and rehabilitation services like physical therapy. Unfortunately, surgery is not an option for treatment.

Causes

What causes head injuries and brain injuries in children?
Virtually any type of trauma can cause a head injury or brain injury in a child. The most common causes are:

• falls
• motor vehicle accidents (in which the child is either riding as a passenger, or is struck as a pedestrian)
• child abuse
   

Signs and symptoms

What are the symptoms of a head injury/brain injury?
The following list contains the most common symptoms of a head injury. However, it’s critical to recognize that each child may experience symptoms differently, depending on the exact circumstances and severity of his injury. Be sure to seek professional medical attention to get the right diagnosis and care plan for your child.

Symptoms of a mild head injury

• raised, swollen area at the site of the blow
• small, superficial (shallow) cut in the scalp
• headache
• sensitivity to noise and light
• irritability
• confusion
• lightheadedness and/or dizziness
• problems with balance
• nausea
• problems with memory and/or concentration
• change in sleep patterns (difficulty sleeping, or excessive sleepiness)
• blurred vision
• "tired" eyes
• ringing in the ears (tinnitus)
• complaining of strange or altered taste
• fatigue/lethargy

Symptoms of a moderate to severe head injury

All of the above, plus:

• deep cut or laceration in the scalp
• loss of consciousness
• severe headache that does not go away
• repeated nausea and vomiting
• loss of short-term memory, such as difficulty remembering the events that led right up to and through the trauma
• slurred speech
• difficulty standing/walking
• weakness in one side or area of the body
• sweating profusely
• unnaturally pale complexion
• seizures or convulsions
• behavior changes, including sudden irritability
• blood or clear fluid draining from the ears or nose
• in the case of a brain injury, one pupil (dark area in the center of the eye) appearing larger than the other eye

Always seek immediate medical treatment if your child displays any of these warning signs.

 
FAQ

Q: Will my child be OK?
A: The severity of a head injury can vary widely, depending on:

• the type of injury
• whether the brain is involved
• the child’s age
• whether she sustained any other injuries at the same time
• the symptoms she is experiencing

The most important thing you can do for your child is to seek prompt medical attention from a qualified professional. The earlier a head injury is diagnosed and treated, the better the general outlook.

Q: How common are pediatric brain injuries?
A: The Brain Injury Association of America reports that nearly 650,000 children sustain brain injuries each year.

Q: Can head injuries/brain injuries be prevented?
A: Unfortunately, there is no way to completely prevent a head or brain injury: There is no type of headgear or rollbar that offers 100-percent protection.

However, there are several steps you can take to reduce the likelihood of your child suffering a head injury:

• Promote a safe playing environment.
• Always ensure that your child is wearing a seat belt, or properly secured in a car seat, whenever she is in the car.
• Always have your child wear a helmet while bicycle riding, in-line skating, skateboarding and performing any other sports or activities that carry a risk of head trauma.

Q: What do the terms “open head injury” and “closed head injury” mean?
A: An open head injury means that the scalp has been penetrated. A closed head injury involves a hard blow that does not pierce the scalp.

Q: What do I need to look out for once my child has been diagnosed with a head injury?
A: Parents of children diagnosed with a head injury should always be watchful for changes in their child’s:

• balance/coordination
• speech
• pupil size
• sleep patterns
• behavior

Q: Is there a cure for a head or brain injury?
A: The answer hinges on the type of injury sustained. Mild to moderate head and brain injuries can resolve completely, or with minimal complications, with time, rest and proper medical care. Unfortunately, severe brain injuries may cause permanent damage. Learn more in our “Lifelong considerations” section. 

Questions to ask your doctor

You and your family play an essential role in your child’s treatment for a head injury or brain injury. It’s important that you share your observations and ideas with your child’s treating physician, and that you have all the information you need to fully understand the treatment team’s explanations and recommendations.

You’ve probably thought of many questions to ask about your child’s head injury. It’s often very helpful to jot down your thoughts and questions ahead of time and bring them with you, along with a notebook, to your child’s appointment. That way, you’ll have all of your questions in front of you when you meet with your child’s treating clinician and can make notes to take home with you.

Some questions to ask your doctor might include:

• How did you arrive at this diagnosis?
• Are there any other conditions my child might have in addition, or instead?
• What type of head injury does my child have?
• How severe is my child’s head injury? Is his brain affected?
• Is surgery necessary?
• What is the long-term prognosis for my child?
• Do you anticipate problems with learning and memory? What about personality changes or emotional problems?
• Do I need to restrict my child’s physical activity?
• How will the injury affect my child’s home and school life?
• Do I need to make any other changes to my child’s daily routines?
• What other resources can you point me to for more information?



Did you know?
Brain injury is the leading sports-related cause of death in children.