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About Pediatric Trauma

Pediatric trauma is injury to the brain or head during birth, infancy or childhood. Most instances of trauma require only observation, rest and ice. However, for more serious head trauma, treatment may consist of surgically implanting a device to monitor brain swelling and performing open surgery to control brain swelling or bleeding and repair injury.

From the time a child is born and begins developing, he or she is subject to various types of head trauma. Most often, the injuries are accidental, and most often, surgical treatment is not needed. Generally, the types of injuries during infancy and childhood include the following. These are known as primary injuries because they are the initial trauma to the head or brain:

  • Scalp laceration
  • Cerebral contusion
  • Skull fracture
  • Intracerebral hemorrhage
  • Intracranial hematoma
  • Diffuse axonal injury
  • Concussion

A primary injury triggers inflammation of brain tissue and cerebral edema, which are both appropriate reactions to injury. However, inflammation and cerebral edema can cause secondary injury to the brain. The reason secondary injury occurs is that the brain is enclosed in the skull with little unoccupied space. When the brain swells, its delicate tissue is forced against the inside of the skull, producing additional harm.

Fortunately, an infant’s skull has open sutures and the fontanelle, allowing the skull to expand ever so slightly to accommodate the swelling. Despite this, brain swelling is serious and must be detected and treated. Therefore, intracranial pressure may need to be monitored for a few days after serious head trauma.

On very rare occasions, babies undergo head trauma as they pass through the birth canal. Most injuries are benign and do not require surgical treatment. For instance, contusion on the scalp, small skull fractures and cephalohematoma can occur during delivery and all usually resolve on their own.

Another possible injury during delivery is brachial plexus injury. This injury arises from the stretching of the nerves as the baby is being delivered, and the injury may range from subtle weakness to complete loss of use of the arm. For most babies, the injury improves spontaneously or with physical therapy, but under rare circumstances, surgery may be required if arm function does not return.

During infancy, a baby can accidentally topple over, or off a surface, such as a changing table, and hit his or her head. The types of injuries associated with such falls are primarily contusions on the scalp, and only rarely do skull fractures or intracerebral hemorrhages occur. If the baby quickly returns to normal activity, then usually he or she is fine and does not need to be taken to a physician.

It is difficult to say how far a child must fall to suffer a more substantial injury, but a general guideline is that falls of about four feet or less are tolerated well. Of course, the type of floor and how the head hits the floor are also important factors; it is possible to fall shorter distances and sustain serious injuries under unusual circumstances. If a parent or caregiver is not sure whether to be concerned after a fall, he or she may wish to call a physician.

As children grow up and start to ride bikes and play on swings and gym sets, the types of head injuries they sustain are more like those of adults. These include skull fracture, intracranial hematoma, concussion, contusion and intracerebral hemorrhage. Some require surgery and others can be observed without any need for an operation. The best advice for parents is to minimize the risk for these injuries. Strategies to minimize risk include ensuring that children wear bike helmets and seat belts, supervising play and exercising good judgment.

During adolescence, teens are exposed to an array of activities that could lead to accidental head trauma. Such activities include driving, sports, skateboarding and riding a bicycle. Injuries commonly sustained include concussion, skull fracture, intracranial hematoma, contusion and intracerebral hemorrhage. Although head trauma is most often accidental, parents can encourage certain behaviors to minimize a teen’s risk. For instance, parents should make sure their teen knows:

  • Bicycle safety, such as wearing a helmet and crossing streets appropriately
  • Sports safety, such was wearing protective equipment (helmet, pads, mouthguard)
  • Driving safety, such as wearing a seatbelt and driving responsibly

Most important though, if a head injury is sustained, parents should take extra precautions to prevent an additional injury before the first has healed because a second injury can cause an injury worse than the first. Precautions that should be taken include not allowing a teen to play sports or participate in any activities that could risk a second head injury. The teen’s doctor will advise when he or she can resume normal activities.

Other Forms of Trauma
Trauma can come in many forms and be the result of many causes. Although this page describes only the more common types and situations that may result in pediatric trauma, our neurosurgeons are highly experienced in all types and prepared for all situations.

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