Pediatric Trauma
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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.
Symptoms
Symptoms of pediatric trauma vary, depending largely on the type and severity of injury. Some common symptoms include:
- Worsening headaches
- Vomiting
- Seizures
- Lethargy
- Loss of consciousness
- Confusion
- Unusual sleepiness
- Irritability
- Change in behavior
- Refusal to nurse or eat
- Persistent crying among infants
Diagnosis
Diagnosis of pediatric trauma starts with a physical examination, during which the physician acquires a complete medical history of the child and asks the child and parent how the injury occurred.
Also, a neurological examination is performed to identify any alterations in brain function and mental status. This exam consists of evaluating hearing, motor function, swallowing, eye movements, sense of smell, sensation, balance, and coordination.
A child’s mental status is assessed according to the Pediatric Glasgow coma scale, a 15-item scoring system, and the score is used to determine whether head trauma was mild, moderate, or severe. The lower the score, the more severe the injury.
Risk Factors
Pediatric trauma is caused by a direct impact to or vigorous shaking of the body or head. Most often pediatric trauma occurs from motor vehicle accidents, accidental bumps or falls, or recreational activities.
The mechanism by which the brain bruises and tissue becomes damaged is called coup-contrecoup. An impact to the head can cause a bruise at the site of trauma called a coup lesion and a bruise opposite to the site of trauma called a contrecoup lesion. A contrecoup lesion arises when the brain strikes the skull on the opposite side of the site of trauma. The jarring of the brain against the rigid skull can cause shearing of the internal membranes, blood vessels, and tissues, which can possibly lead to bruising, bleeding, or swelling of the brain.
Circumstances that can increase the risk of birth-related head trauma include:
Treatments
At Columbia, our neurosurgeons use the latest surgical advances and techniques to treat each pediatric trauma, providing the best possible outcome.
The course of treatment depends largely on the severity of the injury and may include:
- Rest
- Ice
- Topical antibiotic ointment and adhesive bandage
- Stitches
- Hospitalization for observation
- Immediate surgical attention
