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Three Myths about Childhood Head Injuries

Today's media are partially responsible for some of the myths surrounding head injuries. We see the hapless movie victim fall backwards, striking her head on the brick fireplace, and within seconds, the character dies from the injury. Or after a head injury, a dazed, nearly unconscious teen gets rushed to the ER, while his friends frantically yell at him to stay awake

Yet the reality is far different from the media portrayal of an injured head, so let us separate the myths from the facts.

MYTH #1: Never let a head ­injured child fall asleep

Consider this common scenario: Your 2-year-old twin boys are racing through the house just before bedtime, when one of them falls and strikes his forehead against the doorjamb. He cries immedi­ately (screaming might be more accurate), develops an impressive goose egg, but within minutes, he is active and happy. Bedtime approaches, but you diligently keep him awake using whatever means are necessary. After all, if he falls asleep, he may never wake up. By the time you bring him to the ER, your toddler is extremely cranky from being kept up several hours past his bedtime, and you are exhausted from your efforts. Furthermore, from an ER doctor's point of view, trying to evaluate the mental status of an over-tired and irritable 2-year­old is the ultimate challenge.

Please. Let the poor kid sleep. Sleeping is not the issue. What I want to know is whether or not the child can be awakened. In other words, is he just sleeping, or is he unconscious?

When a person gets bonked on the head, the fragile brain can bruise and swell after bouncing against the much ­harder skull. Head trauma can cause brief unconsciousness, followed by a headache, nausea, or lightheadedness. We refer to this cluster of symptoms as a concussion, and the injury usually resolves over the course of a few days.

What do we do for simple concussions? Not much. Rest, watchful care, and try to avoid any new injuries while the brain heals. (I always feel silly telling parents to keep their 2-year old from playing in any way that would risk a fall or further injury, as if such a thing is humanly possible.)

Your child's goose egg is also not a major source of worry. The scalp and forehead have thick skin, packed with tiny blood vessels. A contusion to this tissue breaks these vessels and they bleed beneath the skin. A goose egg can be impressive in size, but rarely causes any lasting problems.

What we worry about much more than a concussion or a goose egg is bleeding inside the head, between the skull and the brain, or inside the brain itself. This expanding pool of blood, called a hematoma can compress the brain, causing lethargy or unconsciousness. Surgery on this very dangerous injury can be life-saving.

MYTH #2: X-rays are needed to properly diagnose head injuries.

First of all, while X-rays can show if the skull has a fracture, they do not answer the far more important question: How is the brain doing? Secondly, skull fractures usually are benign and rarely require any treatment at all. The only way to properly assess for bleeding inside the skull or brain is with a CT-scan or an MRI, not plain X-rays.  

MYTH #3: Head injuries are not serious if a person who's been knocked-out wakes up within a few minutes.

This is a dangerous myth.

Head injuries can cause slow and subtle bleeding between the brain and the skull, and the signs of such bleeding might not be apparent for several hours. Any child who has been knocked out should be evaluated by a physician, even if the child looks and acts fine. As for the head-injured child who wasn't knocked out-if he or she has a headache, is irritable or vomiting, or "just not acting right" to you-get the child checked out by a physician, too. And certainly if a child continues to scream or cry, he should be checked by a doctor. Take this to mean that prolonged fussiness and crying are red flags for you as a parent.

But please, while you are driving to the doctor, let your fussy child sleep if she wants to. Doctors  have wonderfully annoying ways of waking up patients in the emergency room.


 Written by Steven Sainsbury, M.D., and reprinted from the January/February 2006 issue of Twins Magazine and posted 01-02-06 on



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